[Chilaiditi's sign and syndrome. Case report]. / Signo y síndrome de Chilaiditi. Reporte de caso.

The interposition of a portion of the colon between the liver and the diaphragm is called Chilaiditi sign and discovered incidentally during radiological study for other reasons and usually asymptomatic presentation. When the discovery is accompanied by clinical symptoms such as abdominal pain, nausea, vomiting, bloating, constipation called Chilaiditi Syndrome. The Chilaiditi sign is a very rare condition, and the Chilaiditi syndrome is even more, especially if associated with other acute diseases. We report the case of a man of 41 years was admitted with right upper quadrant abdominal pain, nausea, vomiting, difficulty was diagnosed with radiographic and tomographic images making the differential diagnosis with lung abscess and diaphragmatic hernia. The final diagnosis was Chilaiditi Syndrome associated with acute pancreatitis and penumonia.

La interposición de una parte del colon entre el hígado y el diafragma se llama signo de Chilaiditi, el cual se descubre de forma casual durante un estudio radiológico por otra causa. Su presentación suele ser asintomática. Cuando el hallazgo se acompaña de síntomas clínicos como dolor abdominal, náuseas, vómito, distensión abdominal o estreñimiento se llama síndrome de Chilaiditi. El signo de Chilaiditi es muy raro y aún lo es más el síndrome de Chilaiditi, sobre todo si se asocia con otras patologías agudas. Se presenta el caso clínico de un hombre de 41 años de edad que ingresó por dolor abdominal en el hipocondrio derecho, náuseas y vómito; hubo dificultad diagnóstica ante las imágenes radiológicas y tomográfícas, por lo que se hizo el diagnóstico diferencial con absceso pulmonar y hernia diafragmática. El diagnóstico final fue síndrome de Chilaiditi asociado a pancreatitis y neumonía.

[Chilaiditi’'s sign and syndrome: rare conditions but diagnostically important in pediatrics. Clinical cases]. / Signo y síndrome de Chilaiditi: condiciones infrecuentes pero con importancia diagnóstica en pediatría. Casos clínicos.

Although infrequent, bowel interposition between diaphragm and liver, Chilaiditi’s 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.

Signo y síndrome de Chilaiditi: condiciones infrecuentes pero con importancia diagnóstica en pediatría: casos clínicos / Chilaiditi’s sign and syndrome: rare conditions but diagnostically important in pediatrics: clinical cases

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, Chilaiditi’s 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.

Chilaiditi Sign on 99mTc-Mebrofenin Hepatobiliary Scan Mimicking Bile Leak in Acute Cholecystitis.

Chilaiditi sign is the incidental radiologic finding of intestinal interposition between the liver and diaphragm, whereas Chilaiditi syndrome describes the presence of accompanying clinical symptoms including abdominal pain, constipation, vomiting, and respiratory distress. We describe a case of radiotracer accumulation over the liver dome on Tc-mebrofenin hepatobiliary scan performed on a 72-year-old man with acute cholecystitis mimicking a bile leak. However, chest radiograph and CT revealed intestinal hepatodiaphragmatic interposition. This case illustrates the importance of being familiar with the scintigraphic appearance of the Chilaiditi sign and correlating abnormal nuclear medicine scan findings with other available radiologic modalities.

Síndrome de Chilaiditi / Chilaiditi´s syndrome

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)