Chilaiditi’s Syndrome
Hepatodiaphragmatic Interposition of the Intestine

General Considerations

• Pronounced “Ky-La-Ditty”
• Refers to the usually asymptomatic interposition of the bowel (usually hepatic flexure of the colon) between the liver and the (right) hemidiaphragm
• Seen in 0.1-0.25% of chest x-rays
• Most frequently an incidental finding
• More often in males
• Almost always in adults
• May be present intermittently
• Factors contributing to its occurrence include
• Absence of normal suspensory ligaments of the transverse colon
• Abnormality or absence of the falciform ligament
• Redundant colon, as might be seen with chronic constipation or in bedridden individuals
• Aerophagia
• Paralysis or eventration of the right hemidiaphragm
• Patients with chronic lung disease, cirrhosis and ascites
• The “sign” refers to the usually asymptomatic presence of the interposed bowel

Clinical Findings

• The “syndrome” may involve
• Abdominal pain
• Constipation
• Vomiting
• Respiratory distress
• Anorexia

Imaging Findings

• Chilaiditi’s Syndrome is important because it can simulate pneumoperitoneum
• Look for the presence of haustral folds which can establish the air beneath the diaphragm is contained within large bowel
• Left lateral decubitus abdominal films may help in this distinction
• Concomitant pneumoperitoneum may be more difficult to diagnose
• May require abdominal CT

Chilaiditi's Syndrome. Top: There is interposition of colon between the right
hemidiaphragm and the liver producing a crescentic lucency in the right upper quadrant (white arrow) that can be mistaken for free air. Bottom: Look for the haustral folds in the lucency (yellow arrows) to help establish the air is in the colon.
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