Chilaiditi's syndrome and obesity.

Hepatodiaphragmatic interposition (HDI) of the colon or small intestine (Chilaiditi's syndrome) is more prevalent in the elderly and in men. The reason for this is unclear. In obese individuals, fat deposition between the liver and colon widens this potential space, and this may be an important factor in the etiology of this condition. As men store more fat intra-abdominally than women, this may explain the increased prevalence in men. This study was performed to investigate the relationship between Chilaiditi's syndrome and obesity. A total of 850 abdominal CT examinations were assessed for the presence of HDI of the colon or small intestine, and 10 patients with Chilaiditi's syndrome were identified. The present Body Mass Index (BMI) and the highest BMI in the past was recorded for each patient. Eight of the 10 patients were male; five had a BMI greater than 28.5 and three had a BMI between 25 and 27.5 at some period in their lives. Obesity may be a causative factor in the etiology of Chilaiditi's syndrome, and the difference in fat deposition between men and women may explain its increased prevalence in men.

Magnetic resonance imaging or arthrography for shoulder problems: a randomised study.

OBJECTIVE: Diagnostic technologies are often assessed merely by their accuracy, rather than by their impact on diagnosis and patient management. To this end the authors have undertaken a study to assess the diagnostic and therapeutic impact of magnetic resonance imaging (MRI) and arthrography of the shoulder for patients referred from a rheumatology clinic. METHODS AND PATIENTS: Patients referred from a rheumatology clinic with symptoms warranting imaging of the shoulder were randomised to either MRI or arthrography. Data on the clinician's diagnostic confidence and management were recorded before and after imaging using questionnaires. Patients were followed-up at least 10 months after imaging to see how management plans evolved, and what proportion of patients required further imaging. RESULTS: Fifty three shoulders underwent imaging over a year and entered into the study; 29 randomised to MRI and 24 to arthrography. Both MRI and arthrography had a similar beneficial diagnostic impact in terms of clinical diagnoses (refuted and retained) and new diagnoses established. MRI and arthrography had a similar therapeutic impact, although MRI was associated with a significant shift towards surgical intervention. CONCLUSION: MRI and arthrography a have similar diagnostic and therapeutic impact.