Description

A 3-year-old boy presented with a week’s history of fever, cough and mild shortness of breath, with no history of previous recurring chest or abdominal symptoms. His chest examination demonstrated basal crepts, and his abdominal examination was normal. Chest radiograph showed generalised inflammatory changes in lung fields and a radiolucent shadow under the right diaphragm with some haustral marking suggestive of interposition of colon between the diaphragm and liver (figure 1). This x-ray finding is called Chilaiditi’s sign.

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Figure 1

Chilaiditi’s sign: gas under right diaphragm showing haustral markings (colon interposed between liver and diaphragm ).

Chilaiditi’s sign is a condition characterised by interposition of the small or large bowel between the liver and the right hemidiaphragm. Chilaiditi’s sign is a radiographic term that becomes known as Chilaiditi syndrome when symptoms are present.1 It is a relatively rare condition in adults and children; and its prevalence in the general population ranges from 0.025% to 0.28%.2 Chilaiditi’s sign is generally asymptomatic and identified as an incidental radiographic finding. Occasionally patients with Chilaiditi’s sign have associated symptoms (abdominal pain, constipation, bowel obstruction), which respond to conservative therapy including nasogastric decompression, enemas and fluids.1 ,2

Chilaiditi’s sign should be considered in the differential diagnosis of gas under right diaphragm along with other serious abnormalities including pneumoperitoneum, subphrenic abcesses, diaphragmatic hernias and retroperitineal masses, especially in cases of acute abdomen. Though haustral markings are diagnostic of colonic interposition,3 further imaging (ultrasound, CT scan) may be needed, if plain films are not conclusive of Chiladiti’s syndrome in acute abdomen. Awareness of this condition could help reduce unnecessary exploratory laparotomies for mis-diagnosed pneumo-peritoneum.