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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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