Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contact us Login 
  • Users Online:54
  • Home
  • Print this page
  • Email this page


 
 Table of Contents  
TEACHING IMAGES
Year : 2022  |  Volume : 10  |  Issue : 2  |  Page : 310-311

Is it a diaphragmatic hernia?


Department of Radiology, Mohammed V Military Instruction Hospital, Rabat, MA, Morocco

Date of Submission22-Oct-2022
Date of Acceptance25-Oct-2022
Date of Web Publication23-Dec-2022

Correspondence Address:
Dr. Amine Naggar
Department of Radiology, Mohammed V Military Instruction Hospital, Hay Ryad, Rabat, MA 10100
Morocco
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/amhs.amhs_245_22

Rights and Permissions
  Abstract 


Chilaiditi's syndrome is a symptomatic hepato-diaphragmatic interposition of a colon and/or small intestine. When it is asymptomatic, it is called Chilaiditi's sign. It is a benign condition that may mimic other concerning diagnoses on radiography, such as diaphragmatic hernia or pneumoperitoneum. Computed tomography (CT) is the best imaging tool to assess the diagnosis. We report a rare case of Chilaiditi's syndrome with intermittent dyspnea, suspected on radiography and diagnosed on CT. Nasogastric decompression relieved the patient's symptoms.

Keywords: Chilaiditi's syndrome, colon, dyspnea, tomodensitometry


How to cite this article:
Naggar A, Rostoum S, Retal H, El Fenni J, Saouab R. Is it a diaphragmatic hernia?. Arch Med Health Sci 2022;10:310-1

How to cite this URL:
Naggar A, Rostoum S, Retal H, El Fenni J, Saouab R. Is it a diaphragmatic hernia?. Arch Med Health Sci [serial online] 2022 [cited 2023 Feb 5];10:310-1. Available from: https://www.amhsjournal.org/text.asp?2022/10/2/310/364967




  Introduction Top


Chilaiditi's syndrome is a symptomatic hepato-diaphragmatic interposition of a colon and/or small intestine. When it's asymptomatic it's called Chilaiditi's sign. It's a benign condition that may mimic other concerning diagnoses on Radiography such as diaphragmatic hernia or pneumoperitoneum. Computed Tomography (CT) can be needed, especially when the patient is symptomatic, in order to eliminate the differential diagnoses, and confirm Chilaiditi's syndrome.


  Case Report Top


A 52-year-old male patient, with an unremarkable history, presented for intermittent dyspnea with no associated symptoms. The patient was afebrile with a saturation of oxygen at 98%, with no abnormality on lung auscultation nor on the rest of the clinical examination.

A chest radiography was prescribed [Figure 1], showing air-filling cavities projecting over the basal segments of the right lung and the right mediastinum, responsible for a mediastinal shift to the contralateral side.
Figure 1: Anteroposterior chest radiograph: Air cavities projecting over the basal segments of the right lung and mediastinum. Note the folds outlining the air

Click here to view


What diagnoses can be suggested?

The proposed differential diagnoses were:

  • Diaphragmatic hernia
  • Chilaiditi's syndrome
  • Pulmonary cavitary lesions
  • Mediastinal cavitary lesions
  • Pneumoperitoneum.


The identification of haustra demonstrates that the air is within the intestinal lumen, limiting the differentials to diaphragmatic hernia and Chilaiditi's syndrome.

A chest computed tomography scan was performed [Figure 2], showing the colonic hepatic flexure and the transverse colon abnormally located between the liver and the diaphragm. No herniation through a diaphragmatic hiatus or a diaphragmatic defect, and no pulmonary nor mediastinal lesion were found, confirming thus, Chilaiditi's syndrome as a final diagnosis.
Figure 2: Chest axial CT (a) and sagittal (b) in the mediastinal window: Interposition of the colon (Blue Asterisk) between the diaphragm (Arrows) and the liver (red Asterisk). Yellow Asterisk: Stomach

Click here to view


Bowel decompression was sufficient to relieve the patient's symptoms.


  Discussion Top


Chilaiditi's syndrome is a rare entity, with an incidence of 0.02%-0.22% in the normal population, defined as a symptomatic hepato-diaphragmatic interposition of a colon and/or small intestine. The right colon and transverse colon are the most frequently involved (72%).[1],[2]

Chilaiditi's syndrome is usually asymptomatic. Abdominal pain, nausea, vomiting, constipation, and respiratory distress are the most frequent symptoms;[3] angina-like symptoms are possible but rare. The physical examination in the other hand is without abnormalities.[4]

Conservative treatment should be preferred since symptoms often resolve by using nasogastric decompression and administrating laxatives. Surgery is suggested in case of the persistence of symptoms or in case of complications such as bowel ischemia or bowel obstruction from volvulus.[5] In which case a detorsion with a colopexy must be performed to prevent recurrence, but if the bowel is necrotic, the involved segment must be resected.[6]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his names and initials will not be published, and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Okuş A, Ay S, Çarpraz M. Chilaiditi syndrome. Electron J Gen Med 2013;10:79-82.  Back to cited text no. 1
    
2.
Vessal K, Borhanmanesh F. Hepatodiaphragmatic interposition of the intestine (Chilaiditi's syndrome). Clin Radiol 1976;27:113-6.  Back to cited text no. 2
    
3.
Moaven O, Hodin RA. Chilaiditi syndrome: A rare entity with important differential diagnoses. Gastroenterol Hepatol (N Y) 2012;8:276-8.  Back to cited text no. 3
    
4.
Sorrentino D, Bazzocchi M, Badano L, Toso F, Giagu P. Heart-touching Chilaiditi's syndrome. World J Gastroenterol 2005;11:4607-9.  Back to cited text no. 4
    
5.
Chan SC, Law S, Chu KM. Iatrogenic Chilaiditi's syndrome. Gastrointest Endosc 2002;56:447-9.  Back to cited text no. 5
    
6.
Matsushima K, Suzuki Y. Transverse colon volvulus and associated Chilaiditi's syndrome. Am J Surg 2006;192:203-4.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Case Report
Discussion
References
Article Figures

 Article Access Statistics
    Viewed174    
    Printed10    
    Emailed0    
    PDF Downloaded22    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]