Presentation
Abstract Chilaiditi sign is the peculiar radiographic presentation of interposition of colon between diaphragm and liver. When associated with symptomatology, it is called as chilaiditi’s syndrome. Though rare, respiratory symptoms may be present. [ncbi.nlm.nih.gov]
Generally patients are asymptomatic but non-specific symptoms such as abdominal pain, distension, nausea, vomiting and constipation can be presented. [alliedacademies.org]
The specific symptoms and presentation of Chilaiditi's syndrome can vary greatly from one person to another. The cause of Chilaiditi's syndrome is not fully understood. [rarediseases.org]
The isolated and asymptomatic presentation of such a condition is known as Chilaiditi's sign. [scielo.br]
Patients with recurrent presentations or evidence of bowel ischemia may be offered surgical treatment. Gangrenous or ischemic bowel segments may have to be removed if there is associated colonic volvulus. [radiopaedia.org]
Entire Body System
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Gangrene
Gangrenous or ischemic bowel segments may have to be removed if there is associated colonic volvulus. Otherwise, colopexy may be sufficient to prevent future recurrence of symptoms. [radiopaedia.org]
Cecopexy may be adequate to eliminate the possibility of recurrence in an uncomplicated cecal volvulus, unless gangrene or perforation necessitates surgical resection. [alliedacademies.org]
Cases of volvulus generally require urgent surgical intervention with either colectomy (perforation and gangrene) or colopexy. [scielo.br]
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Swelling
Additional symptoms that have been reported in Chilaiditi’s syndrome include nausea, vomiting, constipation, indigestion (dyspepsia), abnormal twisting of the intestines (volvulus) causing obstruction, abdominal swelling (distention), difficulty swallowing [rarediseases.org]
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Weight Loss
The treatment for Chilaiditi's syndrome is generally conservative, including weight loss, management of aerophagia and ascites, and change in decubitus. [scielo.br]
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Chest Discomfort
discomfort and productive cough for last one month. [ncbi.nlm.nih.gov]
Respiratoric
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Respiratory Distress
Unusual cause of respiratory distress: Chilaiditi syndrome. Pediatrics International. 2004; 46 :188–90. [ PubMed ] [ Google Scholar ] [4] Hotoleanu C, Fodor D, Jurj C, Iancu M, Rusu ML. Sindrom Chilaiditi. [ncbi.nlm.nih.gov]
In some cases, Chilaiditi’s syndrome has been associated with breathing problems (respiratory distress). Causes The exact cause of Chilaiditi’s syndrome is unknown. [rarediseases.org]
"Chilaiditi syndrome as a cause of respiratory distress". Eur. J. Pediatr. 165 (6): 367–9. doi : 10.1007/s00431-005-0077-9. PMID 16489467. Walsh SD, Cruikshank JG (February 1977). "Chilaiditi syndrome". [en.wikipedia.org]
Abdominal pain, constipation, vomiting, respiratory distress, anorexia, volvulus, and obstruction are possible presentations of this syndrome [ 3 ]. Chilaiditi syndrome can be a self-resolving or a chronic condition [ 4 ]. [alliedacademies.org]
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Sputum
Sputum was negative for acid fast bacilli. Chest radiograph revealed bilateral reticular pattern with hypertranslucent shadow below the right diaphragm suggestive of interposition of gut loops between right hemidiaphragm and liver [ Table/Fig-1 ]. [ncbi.nlm.nih.gov]
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Productive Cough
cough for last one month. [ncbi.nlm.nih.gov]
Gastrointestinal
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Abdominal Pain
Chronic, recurrent episodes of abdominal pain are a common finding. Abdominal pain may be mild and come and go (intermittent). However, abdominal pain can be severe and force affected individuals to go to the emergency room. [rarediseases.org]
Chilaiditi syndrome is the anterior interposition of the colon to the liver reaching the under-surface of the right hemidiaphragm with associated upper abdominal pain; it is one of the causes of pseudopneumoperitoneum. [radiopaedia.org]
In recent years, surgical intervention has been increasingly used in order to manage symptoms of chronic, intermittent abdominal pain [ 6 ]. [alliedacademies.org]
"Severe Recurrent Abdominal Pain: An Anatomical Variant of Chilaiditi's Syndrome". MedGenMed. 9 (2): 67. PMC 1994890. PMID 17955121. Plorde JJ, Raker EJ (December 1996). [en.wikipedia.org]
CASE REPORT A female, 56-year-old patient was admitted to the unit of immediate assistance presenting abdominal pain in the previous eight hours. The patient reported intense pain in the epigastrium and in the right shoulder. [scielo.br]
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Recurrent Abdominal Pain
"Severe Recurrent Abdominal Pain: An Anatomical Variant of Chilaiditi's Syndrome". MedGenMed. 9 (2): 67. PMC 1994890. PMID 17955121. Plorde JJ, Raker EJ (December 1996). [en.wikipedia.org]
Severe recurrent abdominal pain: an anatomical variant of Chilaiditi’s syndrome. MedGenMed. 2007;9:67. Keles S, Artac H, Reisli I, Alp H, Koc O. Chilaiditi syndrome as a cause of respiratory distress. Eur J Pediatr. 2006;165:367-369. [rarediseases.org]
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Acute Abdomen
Key words: Chilaiditi's syndrome; Chilaiditi's sign; Acute abdomen; Pneumoperitoneum; Hepatodiaphragmatic space. [scielo.br]
This rare entity should be suspected in patients with abdominal pain, vomiting and free air under the right hemi-diaphragm in their chest x-ray, without the clinical condition of acute abdomen. References Saber AA, Boros MJ. [alliedacademies.org]
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Dysphagia
Additional symptoms that have been reported in Chilaiditi’s syndrome include nausea, vomiting, constipation, indigestion (dyspepsia), abnormal twisting of the intestines (volvulus) causing obstruction, abdominal swelling (distention), difficulty swallowing (dysphagia [rarediseases.org]
He did not have shortness of breath, attacks of syncope, change in appetite, emesis, dysphagia, early satiety, fever, chills, night sweats, melena, hematochezia, or any changes in his bowel habits. No history of similar attacks in the past. [alliedacademies.org]
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Early Satiety
He did not have shortness of breath, attacks of syncope, change in appetite, emesis, dysphagia, early satiety, fever, chills, night sweats, melena, hematochezia, or any changes in his bowel habits. No history of similar attacks in the past. [alliedacademies.org]
Cardiovascular
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Heart Failure
In one case it was complicated by megacol on progressed to heart failure casing death. [alliedacademies.org]
Skin
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Night Sweats
He did not have shortness of breath, attacks of syncope, change in appetite, emesis, dysphagia, early satiety, fever, chills, night sweats, melena, hematochezia, or any changes in his bowel habits. No history of similar attacks in the past. [alliedacademies.org]
Psychiatrical
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Suggestibility
Plain radiograph Features that suggest a Chilaiditi syndrome (i.e. [radiopaedia.org]
The above features were suggestive of ILD. Also seen was the interposition of colon between liver and diaphragm, colonic haustral pattern was seen suggestive of Chilaiditi sign [ Table/Fig-3 ]. [ncbi.nlm.nih.gov]
Plain chest radiography in orthostasis ( Figure 1 ) demonstrated hyper transparency in the right hepatodiaphragmatic region, suggesting the presence of pneumoperitoneum. [scielo.br]
These findings suggested Chilaiditi’s syndrome. Figure 1a and 1b: Erect chest x-ray showing air under right hemi-diaphragm. Figure 2: CT view demonstrate a loop of colon interpositioned between the liver and right hemidiaphragm. [alliedacademies.org]
Workup
Serum
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Hyponatremia
Basic laboratory studies revealed a mild hyponatremia (134.3 mm/dL). Complete blood count was within normal range .Troponin T was 6761pg / ml. [alliedacademies.org]
Biopsy
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Liver Biopsy
It is important to identify Chilaiditi sign in order to prevent complications from occurring during a percutaneous transhepatic procedure or liver biopsy, particularly in cirrhotic patients, who are predisposed to development of Chilaiditi sign. [alliedacademies.org]
Treatment
Treatment and prognosis Asymptomatic patients with Chilaiditi syndrome do not require specific treatment. Those with abdominal pain or distension are usually treated conservatively with analgesia and fluid resuscitation. [radiopaedia.org]
Patient improved partially with treatment and was discharged in a stable condition after a week. Patient was in a clinically stable condition at follow-up at 3 months. [ncbi.nlm.nih.gov]
Standard Therapies Treatment The treatment of Chilaiditi's syndrome is directed toward the specific symptoms that are apparent in each individual. Some affected individuals may not require any therapy. [rarediseases.org]
If the patient is symptomatic, treatment is usually conservative. [alliedacademies.org]
The treatment for Chilaiditi's syndrome is generally conservative, including weight loss, management of aerophagia and ascites, and change in decubitus. [scielo.br]
Prognosis
Treatment and prognosis Asymptomatic patients with Chilaiditi syndrome do not require specific treatment. Those with abdominal pain or distension are usually treated conservatively with analgesia and fluid resuscitation. [radiopaedia.org]
Epidemiology
Epidemiology [ edit ] The occurrence ( incidence ) on abdominal or chest X-rays is around 0.1% but it can be up to 1% in series of older adults. [5] It has also been reported in children. [4] History [ edit ] Chilaiditi's sign is named after the Greek [en.wikipedia.org]
Pathophysiology
A literature review is performed with emphasis on pathophysiology, diagnostic work-up and treatment of this entity. Key words: Chilaiditi's syndrome; Chilaiditi's sign; Acute abdomen; Pneumoperitoneum; Hepatodiaphragmatic space. [scielo.br]
Prevention
Otherwise, colopexy may be sufficient to prevent future recurrence of symptoms. [radiopaedia.org]
It is important to identify Chilaiditi sign in order to prevent complications from occurring during a percutaneous transhepatic procedure or liver biopsy, particularly in cirrhotic patients, who are predisposed to development of Chilaiditi sign. [alliedacademies.org]