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| TEACHING IMAGES |
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| Year : 2022 | Volume
: 10
| Issue : 2 | Page : 310-311 |
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Is it a diaphragmatic hernia?
Amine Naggar, Soufiane Rostoum, Hamza Retal, Jamal El Fenni, Rachida Saouab
Department of Radiology, Mohammed V Military Instruction Hospital, Rabat, MA, Morocco
| Date of Submission | 22-Oct-2022 |
| Date of Acceptance | 25-Oct-2022 |
| Date of Web Publication | 23-Dec-2022 |
Correspondence Address:
Dr. Amine Naggar
Department of Radiology, Mohammed V Military Instruction Hospital, Hay Ryad, Rabat, MA 10100
Morocco
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/amhs.amhs_245_22
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 |
| Introduction | |  |
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 | | |
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
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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
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Bowel decompression was sufficient to relieve the patient's symptoms.
| Discussion | | |
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 | | |
| 1. | Okuş A, Ay S, Çarpraz M. Chilaiditi syndrome. Electron J Gen Med 2013;10:79-82.  |
| 2. | Vessal K, Borhanmanesh F. Hepatodiaphragmatic interposition of the intestine (Chilaiditi's syndrome). Clin Radiol 1976;27:113-6. |
| 3. | Moaven O, Hodin RA. Chilaiditi syndrome: A rare entity with important differential diagnoses. Gastroenterol Hepatol (N Y) 2012;8:276-8. |
| 4. | Sorrentino D, Bazzocchi M, Badano L, Toso F, Giagu P. Heart-touching Chilaiditi's syndrome. World J Gastroenterol 2005;11:4607-9. |
| 5. | Chan SC, Law S, Chu KM. Iatrogenic Chilaiditi's syndrome. Gastrointest Endosc 2002;56:447-9. |
| 6. | Matsushima K, Suzuki Y. Transverse colon volvulus and associated Chilaiditi's syndrome. Am J Surg 2006;192:203-4. |
[Figure 1], [Figure 2]
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