Available from: Rosa Mcnamara, Jan 13, 2015
Volume X, n o . 4 : November 2009 250 Western Journal of Emergency Medicine
im a g e s in em e r g e n c y me d i c i n e
Chilaiditi’s Syndrome
Rosa F. McNamara, MCEM, MRCSEd(A&E), MRCPI*
Stephen Cusack, FCEM, FRCSEd(A&E)*
Patrick Hallihan, MRCS
* Cork University Hospital, Emergency Department, Wilton, Cork, Ireland
Cork University Hospital, Department of Surgery, Wilton, Cork, Ireland
SupervisingSectionEditor: Sean Henderson, MD
Submission history: Submitted September 29, 2009; Accepted October 8, 2009
Reprints available through open access at http://escholarship.org/uc/uciem_westjem
[WestJEM. 2009;10(4):250.]
A 58-year-old man presented to the Emergency
Department with a two-day history of vomiting, diarrhea
and intermittent central abdominal pain. His background
history was signicant for peptic ulcer disease. On
examination there was diffuse abdominal tenderness, and
a fecal occult blood test was positive. A departmental
chest radiograph had appearances suggestive of a
pneumoperitoneum, with an elevated right hemidiaphragm
and subdiaphragmatic free air. The patient was referred to
the surgical team for management of a suspected perforated
duodenal ulcer.
Subsequent CT imaging of thorax and abdomen revealed
hepato-diaphragmatic interposition of the transverse colon,
as well as extensive colitis. He was managed conservatively
and discharged home well after four days.
Chilaiditis sign is the appearance of free air under the
diaphragm caused by interposition of the transverse colon
between the liver and diaphragm. It is usually asymptomatic
and is an incidental nding. It is estimated to occur in 0.25%
to 0.28% of the general population
and was rst described
by Demetrious Chilaiditi in 1910.
When the sign is observed
in association with symptoms such as abdominal pain or
vomiting it is termed Chilaiditi’s syndrome. It is in this
scenario that the radiographic ndings may be mistaken for
pneumoperitoneum, as occurred in this case.
AddressforCorrespondence: Rosa McNamara, MRCPI,
MRCSEd(A&E), MCEM. Department of Emergency
Medicine,Cork University Hospital, Wilton, Cork,Ireland. Email
Risaliti A, DeAnna D, Terrosu G, et al. Chilaiditis’s syndrome 1.
as a surgical and non surgical problem. Surg Gynecol Obstet.
Chilaiditi D. Zur Frage der Hapatoptose und Ptose in allgemeinen im 2.
Auschluss an drei FŠlle von temporŠrer partieller Leberverlagerung.
Fortschritte auf dem Gebiete der Roentgenstrahlen. 1910;11:173-208.
Figure. Chest radiograph suggestive of a pneumoperitoneum, with
an elevated right hemidiaphragm and subdiaphragmatic free air.
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    [Show abstract] [Hide abstract] ABSTRACT: A rare syndrome, Chilaiditi's syndrome is interposition of the colon only or with the small intestine in hepatodiaphragmatic area. It may be asymptomatic, but it may also present with symptoms, such as abdominal pain, nausea, vomiting, constipation and respiratory distress. We present a patient who was admitted with urological problems; he was incidentally diagnosed with Chilaiditi's syndrome.
    Full-text · Article · Apr 2012 · Canadian Urological Association journal = Journal de l'Association des urologues du Canada
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    [Show abstract] [Hide abstract] ABSTRACT: Chilaiditi syndrome, first described in 1910 by the radiologist Chilaiditi from Vienna, is the interposition of right colon between liver and right hemi diaphragm. It occurs most often in males and its incidence increases with age. It is often detected incidentally during radiological examination. It's rarely symptomatic; symptoms can differ from mild abdominal pain to severe acute intestinal obstruction. Our case applied to emergency service with right flank pain. There was no calculus or dilatation in the urinary system at non-contrast abdominopelvic computerized tomography. Ascending colon was interposed between liver and diaphragm so that the patient was diagnosed as Chiliaditi syndrome. The patient was treated conservatively and discharged with dietary suggestions by the gastroenterology consultant. The conclusion of this report is that the Chilaiditi syndrome must be considered in differential diagnosis for patients presenting with urinary colic pain symptoms with no urinary pathology on radiologic imaging.
    Full-text · Article · Sep 2014