ABSTRACT
Figura 1. Tomografía Computarizada de tórax (corte coronal). Se observan ambos campos pulmonares y las cavidades cardiacas. La flecha roja señala el área hipodensa ovalada correspondiente al aire dentro de un asa de colon interpuesta entre el hemidiafragma derecho (línea hiperdensa arriba) y el borde superior del hígado (abajo), causando una depresión del borde superior del hígado. Fuente: tomada de la historia clínica, previa autorización del paciente.
Figure 1. Chest Computed Tomography Scan (coronal plane) Both lung fields and cardiac chambers are observed. The red arrow indicates the oval hypodense area corresponding to the air inside the loop of colon interposed between the right hemidiaphragm (hyperdense line up) and superior border of the liver (down), causing a depression of the superior border of the liver. Source: taken with authorization from the patient's medical record.
Figura 1. Tomografia Computadorizada de tórax (corte coronal). Observam-se ambos os campos pulmonares e as cavidades cardíacas. A seta vermelha aponta para a área hipodensa oval correspondente ao ar dentro de uma alça do cólon interposta entre o hemidiafragma direito (linha hiperdensa acima) e a borda superior do fígado (abaixo), causando uma depressão da borda superior do fígado. Fonte: obtida com permissão do histórico clínico do paciente.
Subject(s)
Chilaiditi Syndrome , Pneumoperitoneum , Diagnostic Imaging , Tomography, X-Ray Computed , Abdominal PainABSTRACT
Chilaiditi syndrome is an extremity rare disease that is typically asymptomatic, but can lead to fatal complications, such as volvulus, perforation, and bowel obstruction. This paper reports a case of an 80-year-old female patient who was admitted for right upper quadrant pain and nausea. She showed a positive Murphy sign with tenderness in the right upper quadrant area. Abdominal ultrasound showed that the gall bladder was normal, but abdominal computed tomography revealed multiple small bowel loops interposed among the liver and diaphragm, as well as an abrupt small transition in the bowel caliber with air fluid levels. Therefore, she was diagnosed with an acute small bowel obstruction by Chilaiditi syndrome. She was managed with surgical repair and was discharged without complications after 18 days of admission. Small bowel obstructions by Chilaiditi syndrome is one etiology of which every emergency physician should be aware.
Subject(s)
Aged, 80 and over , Female , Humans , Chilaiditi Syndrome , Diaphragm , Emergencies , Extremities , Intestinal Obstruction , Intestinal Volvulus , Intestine, Small , Liver , Nausea , Rare Diseases , Ultrasonography , Urinary BladderABSTRACT
Resumen El signo de Chilaiditi es un hallazgo radiográfico infrecuente que consiste en la interposición de un asa intestinal entre el hígado y el diafragma. No existe etiología claramente establecida; sin embargo, se han planteado varias hipótesis que explican su presencia, entre ellos la hiperlaxitud de los ligamentos suspensorios del hígado, el aumento de la presión intraabdominal y la redundancia colónica. Al asociarse este hallazgo con síntomas gastrointestinales o respiratorios se denomina síndrome de Chilaiditi, y su tratamiento principalmente es sintomático, en casos excepcionales requiere abordaje quirúrgico. Este signo se encuentra usualmente de manera incidental y se ha visto una relación con enfermedad respiratoria crónica; pudiendo afectar su curso clínico, motivando a profundizar en el estudio integral. Se presenta el caso de un paciente adulto mayor, en seguimiento médico por enfermedad pulmonar obstructiva crónica, cuya radiografía de tórax evidencia la interposición de un asa intestinal entre la cúpula diafragmática derecha y el hígado. MÉD.UIS. 2018;31(3):57-61.
Abstract The Chilaiditi sign is a rare radiographic finding, which consists in the interposition of an intestinal handle between the liver and the diaphragm. There is no clear etiology established, however, several hypotheses have been proposed to explain its presence, including the hyper-laxity of the liver suspensory ligaments, an increase on the intra-abdominal pressure and colonic redundancy. When this finding is associated with gastrointestinal or respiratory symptoms is called "Chilaiditi syndrome", and its treatment is mainly symptomatic; in exceptional cases a surgical approach is required. The Chilaiditi sign is usually an incidental finding, and a connection with chronic respiratory disease has been seen, and it could affect this pathology's clinical course, being this a motivation to deepen in an integral study. We present a case of an elder patient, being followed due to chronic obstructive pulmonary disease, whose chest X-ray shows interposition of an intestinal handle between the right diaphragmatic dome and the liver. MÉD.UIS. 2018;31(3):57-61.
Subject(s)
Humans , Male , Aged, 80 and over , Chilaiditi Syndrome , Radiography, Thoracic , Pulmonary Disease, Chronic ObstructiveABSTRACT
Aunque poco frecuente, la interposición de intestino entre el diafragma y el hígado, signo o síndrome de Chilaiditi (en relación a la ausencia o presencia de síntomas gastrointestinales), constituye una condición clínica de importancia dadas las posibilidades de diagnóstico diferencial, tales como: neumoperitoneo, hernia diafragmática y absceso subfrénico. OBJETIVO: Presentar dos preescolares con signo y síndrome de Chilaiditi, así como resaltar la importancia de esta condición clínica. CASOS CLÍNICOS: Caso 1: Preescolar varón evaluado por cuadro respiratorio sin síntomas abdominales. La radiografía de tórax mostró infiltrados retrocardíacos izquierdos y presencia de aire en región subdiafragmática derecha. En radiografías previas se encontraba la misma imagen. Se concluyó que se trataba de un signo de Chilaiditi asociado a un cuadro de neumonía, se trató con antibioterapia y se dio de alta. Caso 2: Preescolar de sexo femenino, evaluada por distensión abdominal y constipación. Radiografía de tórax, solicitada previamente por cuadro respiratorio, con imagen de colon derecho situado entre el hemidiafragma y el hígado. Enema baritado de colon confirmó los hallazgos. Exámenes de laboratorio normales. Se concluyó síndrome de Chilaiditi, se indicó tratamiento médico, con buena evolución. CONCLUSIÓN: Se resalta la importancia de esta condición clínica que pese a ser infrecuente constituye un reto diagnóstico en los servicios de urgencia.
Although infrequent, bowel interposition between diaphragm and liver, Chilaiditis sign or syndrome (without or with gastrointestinal symptoms), are a major clinical condition given the possibilities of differential diagnosis, such as pneumoperitoneum, diaphragmatic hernia and subphrenic abscess. Objective: To report the cases of two preschool patients with Chilaiditi´s sign and syndrome, as well as to highlight the importance of this clinical condition. Clinical cases: Case 1: A male preschooler evaluated by respiratory disease without abdominal symptoms. Thorax X-ray shows left retrocardiac infiltrates and air in right subdiaphragmatic region. Previous radiographies shows the same image. He was diagnosed with Chilaiditi sign associated with pneumonia, antibiotics were used before discharge. Case 2: A female preschooler, evaluated by abdominal distention and constipation. A previous thorax X-ray shows bowel interposition between diaphragm and liver. Barium enema confirmed the findings. Blood test were normal. A Chilaiditi's syndrome was diagnosed. She received medical treatment with favorable evolution. Conclusion: These cases highlight the importance of this clinical condition that, despite being infrequent, constitutes a diagnostic challenge in the emergency services.
Subject(s)
Humans , Male , Female , Child, Preschool , Chilaiditi Syndrome/diagnostic imaging , Radiography , Chilaiditi Syndrome/complicationsABSTRACT
Chilaiditi sign refers to the presence of bowel gas under the right diaphragm which is similar in appearance to a pneumoperitoneum on radiography, and is caused by abnormal anatomic positioning of the colon or small bowel between the liver and the diaphragm. When symptoms are present, this condition is known as Chilaiditi syndrome. The most common symptoms are gastrointestinal. It has been less commonly associated with chronic, recurrent respiratory distress. We report acute respiratory distress without gastrointestinal symptoms exacerbated by Chilaiditi syndrome in a pneumonia patient with no history of chronic respiratory disease.
Subject(s)
Humans , Chilaiditi Syndrome , Colon , Diaphragm , Hernia, Diaphragmatic , Liver , Pneumonia , Pneumoperitoneum , RadiographyABSTRACT
Chilaidit’s syndrome is a rare condition characterised by the interposition of the colon between the liver and the right hemidiaphragm. We present a case of 20-year-old male who reported with breathlessness and epigastric pain, and he was diagnosed radiologically to have Chilaiditi’s syndrome.
Subject(s)
Chilaiditi Syndrome/diagnosis , Chilaiditi Syndrome/diagnostic imaging , Humans , Male , Tomography, X-Ray Computed , Young AdultABSTRACT
We present a case of 50 year old male patient with coexistence of Pneumothorax and Chilaiditi sign. Chilaiditi sign is an incidental radiographic finding of a usually asymptomatic condition in which a part of intestine is located between the liver and diaphragm; however, the term "Chilaiditi syndrome" is used for symptomatic hepatodiaphragmatic interposition. The patient had no symptoms of abdominal pain, constipation, diarrhea, or emesis. Incidentally, Chilaiditi sign was diagnosed on chest radiography. Pneumothorax is defined as air in the pleural space. Pneumothoraces are classified as spontaneous or traumatic. Spontaneous pneumothorax is labelled as primary when no underlying lung disease is present, or secondary, when it is associated with pre-existing lung disease. Our case is the rare in the literature indicating the coexistence of Chilaiditi sign and pneumothorax.
Subject(s)
Humans , Male , Middle Aged , Chest Pain , Chilaiditi Syndrome , Diagnosis , Dyspnea , Pneumothorax , DiagnosisABSTRACT
Chilaiditi Syndrome is the transposition of right colon in between liver and right hemidiaphragm. This is a rare syndrome which can be easily mistaken for more serious abnormality like perforated viscus. Here we report on elderly female who presented with Chilaiditi Syndrome.
Subject(s)
Abdominal Pain/etiology , Abdominal Pain/therapy , Chilaiditi Syndrome/diagnosis , Chilaiditi Syndrome/epidemiology , Chilaiditi Syndrome/diagnostic imaging , Chilaiditi Syndrome/therapy , Female , Humans , Middle AgedABSTRACT
Chilaiditi's sign refers to a condition in which the right colon or, rarely, the small intestine is interposed between the liver and the right hemidiaphragm. Recognizing this sign is important, because it may present with a variety of abdominal symptoms and may be confused with a surgical abdomen leading to unnecessary surgical intervention. Management is usually conservative unless complications such as volvulus or obstruction occur. Previous reports focused on the complications and surgical management of Chilaiditi's sign. We present a report of three cases of Chilaiditi's sign that were managed non-surgically, together with an updated review of the English literature.
Subject(s)
Adult , Humans , Abdomen , Chilaiditi Syndrome , Colon , Intestinal Volvulus , Intestine, Small , LiverABSTRACT
No abstract available.
Subject(s)
Aged , Humans , Male , Chilaiditi Syndrome/diagnosis , Colonic Neoplasms/diagnosis , Colonoscopy , Intestinal Mucosa/surgeryABSTRACT
A interposição permanente ou temporária do cólon, intestino delgado ou estômago no espaço hepatodiafragmático é conhecido como sinal de Chilaiditi, sendo geralmente assintomático. É evidenciado normalmente em um exame radiológico de rotina. A sua incidência é de 0,025% nos exames radiológicos em todas as idades, aumentando levemente nos pacientes maiores de 60 anos, sendo mais comuns em homens do que em mulheres, com uma relação de 4:1. A associação do sinal de Chilaiditi com sintomas como dor abdominal, náuseas, volvo intestinal, dor retroesternal, sintomas respiratórios, vômitos, distensão abdominal, obstrução ou suboclusão intestinal caracteriza a síndrome de Chilaiditi. No presente estudo, apresentamos um novo caso do sinal de Chilaiditi observado ocasionalmente ao exame radiológico de abdome (AU)
The permanent or temporary interposition of the colon, small intestine or stomach in between the liver and the diaphragm is known as Chilaiditi's sign, usually being asymptomatic. The condition is usually diagnosed in routine X-rays. Its incidence is 0.025% in radiological scans in all age groups, with a slight increase in patients over 60. It is more common in males than females in a ratio of 4:1. The association of Chilaiditi's sign with symptoms of abdominal pain, nausea, intestinal volvus, retrosternal pain, respiratory symptoms, vomiting, abdominal distension, intestinal obstruction or sub-occlusion characterizes the Chilaiditi syndrome. Here we report the case of Chilaiditi's sign as detected in abdominal X-rays (AU)
Subject(s)
Humans , Male , Adult , Colon/abnormalities , Chilaiditi Syndrome/diagnostic imaging , Colonic Diseases/diagnostic imaging , Chilaiditi Syndrome/therapyABSTRACT
A hepatodiaphragmatic interposition of the small or large intestine, which is known as Chilaiditi's syndrome, is generally asymptomatic and rarely requires surgical intervention. However, it can be associated with symptoms ranging from mild abdominal pain to a severe complicated intestinal obstruction. We report a case of Chilaiditi's syndrome associated with an ileal obstruction. A 69 year-old female patient presented with abdominal pain, vomiting and an abdominal distension. The abdominal CT and upper endoscopy findings showed an intestinal obstruction and gastric cancer, requiring surgery.
Subject(s)
Aged , Female , Humans , Abdominal Pain , Chilaiditi Syndrome , Endoscopy , Ileum , Intestinal Obstruction , Intestine, Large , Stomach Neoplasms , Tomography, X-Ray Computed , VomitingABSTRACT
Chilaiditi's sign is a radiographic term used when the hepatic flexure of colon is seen interposed between the liver and right hemidiaphragm. Mostly asymptomatic, Chilaiditi's syndrome can present with abdominal pain, nausea, vomiting, anorexia, abdominal distension, tender hepatomegaly and change in bowel habits. Uncommon in childhood, the incidence seems to increase with age. We have experienced a case of Chilaiditi's syndrome presenting with vomiting in a 15-month-old boy. The patient recovered uneventfully.
Subject(s)
Humans , Infant , Male , Abdominal Pain , Anorexia , Chilaiditi Syndrome , Colon , Hepatomegaly , Incidence , Liver , Nausea , VomitingABSTRACT
Chilaiditis syndrome is very rare clinical condition that interposed of the hepatic flexure of large bowels between the liver and diaphragm. Clinically it is characterized by abdominal pain that becomes increasingly worse during the day and is often accentuated by deep breathing. On radiologic studies, it shows gas within the hepatic flexure interposed between the liver and diaphragm, which is simulating a pneumoperitoneum. A case was admitted at emergency care center of Yeungnam university hospital and we report it.