Chilaiditi syndrome

Chilaiditi syndrome
Synonyms	Chilaiditi's sign
Pronounce
Field	General surgery
Symptoms
Complications
Onset
Duration
Types
Causes
Risks
Diagnosis
Differential diagnosis
Prevention
Treatment
Medication
Prognosis
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Chest X-ray of the same patient as the picture above. A small crescent of air can be seen under the right part of the diaphragm, caused by Chilaiditi's sign. However, it could easily be mistaken for free intra-abdominal air (pneumoperitoneum) which could mistakenly be attributed to bowel perforation.

Chilaiditi syndrome is a rare condition when pain occurs due to transposition of a loop of large intestine (usually transverse colon) in between the diaphragm and the liver, visible on plain abdominal X-ray or chest X-ray.<ref name="pmid15869145">,

 Chilaiditi's syndrome: what should every surgeon know?, 
 Am Surg, 
 
 Vol. 71(Issue: 3),
 pp. 261–3,
 
 PMID: 15869145,</ref>

Normally this causes no symptoms, and this is called Chilaiditi's sign. The sign can be permanently present, or sporadically. This anatomical variant is sometimes mistaken for the more serious condition of having air under the diaphragm (pneumoperitoneum) which is usually an indication of bowel perforation, possibly leading to surgical interventions.

Chilaiditi syndrome refers only to complications in the presence of Chilaiditi's sign. These include abdominal pain,<ref name="pmid17955121">,

 Severe Recurrent Abdominal Pain: An Anatomical Variant of Chilaiditi's Syndrome, 
 MedGenMed, 
 2007,
 Vol. 9(Issue: 2),
 pp. 67,
 
 PMID: 17955121,
 PMC: 1994890,</ref> torsion of the bowel (transverse colon volvulus)<ref name="pmid8946999">, 
 Transverse colon volvulus and associated Chilaiditi's syndrome: case report and literature review, 
 Am. J. Gastroenterol., 
 
 Vol. 91(Issue: 12),
 pp. 2613–6,
 
 PMID: 8946999,</ref> or shortness of breath.<ref name="pmid16489467">, 
 Chilaiditi syndrome as a cause of respiratory distress, 
 Eur. J. Pediatr., 
 
 Vol. 165(Issue: 6),
 pp. 367–9,
 DOI: 10.1007/s00431-005-0077-9,
 PMID: 16489467,</ref>

Causes

The exact cause is not always known, but it may occur in patients with a long and mobile colon (dolichocolon), chronic lung disease such as emphysema, or liver problems such as cirrhosis and ascites. Chilaiditi's sign is generally not associated with symptoms, and is most commonly an incidental finding in normal individuals.

Absence or laxity of the ligament suspending the transverse colon or of the falciform ligament are also thought to contribute to the condition. It can also be associated with relative atrophy of the medial segment of the left lobe of the liver. In this case, the gallbladder position is often anomalous as well – it is often located anterior to the liver, rather than posterior.

Epidemiology

The occurrence (incidence) on abdominal or chest X-rays is around 0.1% but it can be up to 1% in series of older adults.<ref name="pmid842405">,

 Chilaiditi syndrome, 
 Age Ageing, 
 
 Vol. 6(Issue: 1),
 pp. 51–7,
 DOI: 10.1093/ageing/6.1.51,
 PMID: 842405,
 
 
 Full text,</ref> It has also been reported in children.<ref name="pmid16489467" />

History

Chilaiditi's sign is named after the Greek radiologist Dimítrios Chilaiditi, born in 1883, who first described it when he was working in Vienna in 1910.<ref>D. Chilaiditi: Zur Frage der Hepatoptose und Ptose im allgemeinen im Anschluss an drei Fälle von temporärer, partieller Leberverlagerung. Fortschritte auf dem Gebiete der Röntgenstrahlen

, 1910, 16: 173-208.</ref><ref name=WhoNamedIt>synd/2326 at Who Named It?</ref>

Synonyms

Synonyms include interpositio hepatodiaphragmatica, subphrenic displacement of the colon, subphrenic interposition syndrome and pseudopneumoperitoneum.

References

http://www.jmedsoc.org/text.asp?2018/32/3/222/252005.

External links

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