Chilaiditi syndrome

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Chilaiditi syndrome
Other namesChilaiditi's sign
Chilaiditi obvious.jpg
Chest X-ray showing obvious Chilaiditi's sign, or presence of gas in the right colic angle between the liver and right hemidiaphragm.
Specialty General surgery
Symptoms Abdominal pain, dyspnea or asymptomatic
Differential diagnosis Pneumoperitoneum
Frequency0.1% of adults
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 1.PNG
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. [1]

Contents

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, [2] torsion of the bowel (transverse colon volvulus) [3] or shortness of breath. [4]

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. [5] It has also been reported in children. [4]

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. [6] [7]

Synonyms

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

Related Research Articles

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Hernia Abnormal exit of tissues or organs from the cavity they usually reside in

A hernia is the abnormal exit of tissue or an organ, such as the bowel, through the wall of the cavity in which it normally resides. Hernias come in a number of types. Most commonly they involve the abdomen, specifically the groin. Groin hernias are most commonly of the inguinal type but may also be femoral. Other hernias include hiatus, incisional, and umbilical hernias. Symptoms are present in about 66% of people with groin hernias. This may include pain or discomfort, especially with coughing, exercise or going to the bathroom. Often, it gets worse throughout the day and improves when lying down. A bulging area may appear that becomes larger when bearing down. Groin hernias occur more often on the right than left side. The main concern is strangulation, where the blood supply to part of the bowel is blocked. This usually produces severe pain and tenderness in the area. Hiatus, or hiatal, hernias often result in heartburn but may also cause chest pain or pain with eating.

Hiatal hernia Type of hernia in which abdominal organs (typically the stomach) slip through the diaphragm into the middle compartment of the chest

A hiatal hernia is a type of hernia in which abdominal organs slip through the diaphragm into the middle compartment of the chest. This may result in gastroesophageal reflux disease (GERD) or laryngopharyngeal reflux (LPR) with symptoms such as a taste of acid in the back of the mouth or heartburn. Other symptoms may include trouble swallowing and chest pains. Complications may include iron deficiency anemia, volvulus, or bowel obstruction.

Bowel obstruction Medical condition

Bowel obstruction, also known as intestinal obstruction, is a mechanical or functional obstruction of the intestines which prevents the normal movement of the products of digestion. Either the small bowel or large bowel may be affected. Signs and symptoms include abdominal pain, vomiting, bloating and not passing gas. Mechanical obstruction is the cause of about 5 to 15% of cases of severe abdominal pain of sudden onset requiring admission to hospital.

Gastric dilatation volvulus A medical condition in dogs

Gastric dilatation volvulus (GDV), also known as gastric dilation, twisted stomach, or gastric torsion, is a medical condition that affects dogs in which the stomach becomes overstretched and rotated by excessive gas content. The word bloat is often used as a general term to mean gas distension without stomach torsion, or to refer to GDV.

Abdominal pain Stomach aches

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Diverticulitis Digestive disease caused by an inflammation of a herniating pouch (diverticulum)

Diverticulitis, specifically colonic diverticulitis, is a gastrointestinal disease characterized by inflammation of abnormal pouches—diverticula—which can develop in the wall of the large intestine. Symptoms typically include lower abdominal pain of sudden onset, but the onset may also occur over a few days. There may also be nausea; and diarrhea or constipation. Fever or blood in the stool suggests a complication. Repeated attacks may occur.

Gastrointestinal disease Medical condition

Gastrointestinal diseases refer to diseases involving the gastrointestinal tract, namely the oesophagus, stomach, small intestine, large intestine and rectum, and the accessory organs of digestion, the liver, gallbladder, and pancreas.

Percutaneous endoscopic gastrostomy

Percutaneous endoscopic gastrostomy (PEG) is an endoscopic medical procedure in which a tube is passed into a patient's stomach through the abdominal wall, most commonly to provide a means of feeding when oral intake is not adequate. This provides enteral nutrition despite bypassing the mouth; enteral nutrition is generally preferable to parenteral nutrition. The PEG procedure is an alternative to open surgical gastrostomy insertion, and does not require a general anesthetic; mild sedation is typically used. PEG tubes may also be extended into the small intestine by passing a jejunal extension tube through the PEG tube and into the jejunum via the pylorus.

Intussusception (medical disorder) Medical condition

Intussusception is a medical condition in which a part of the intestine folds into the section immediately ahead of it. It typically involves the small bowel and less commonly the large bowel. Symptoms include abdominal pain which may come and go, vomiting, abdominal bloating, and bloody stool. It often results in a small bowel obstruction. Other complications may include peritonitis or bowel perforation.

Volvulus Twisting of part of the intestine, causing a bowel obstruction

A volvulus is when a loop of intestine twists around itself and the mesentery that supports it, resulting in a bowel obstruction. Symptoms include abdominal pain, abdominal bloating, vomiting, constipation, and bloody stool. Onset of symptoms may be rapid or more gradual. The mesentery may become so tightly twisted that blood flow to part of the intestine is cut off, resulting in ischemic bowel. In this situation there may be fever or significant pain when the abdomen is touched.

Intestinal malrotation is a congenital anomaly of rotation of the midgut. It occurs during the first trimester as the fetal gut undergoes a complex series of growth and development. Malrotation can lead to a dangerous complication called volvulus. Malrotation can refer to a spectrum of abnormal intestinal positioning, often including:

Gastrointestinal perforation Medical condition

Gastrointestinal perforation, also known as ruptured bowel, is a hole in the wall of part of the gastrointestinal tract. The gastrointestinal tract includes the esophagus, stomach, small intestine, and large intestine. Symptoms include severe abdominal pain and tenderness. When the hole is in the stomach or early part of the small intestine the onset of pain is typically sudden while with a hole in the large intestine onset may be more gradual. The pain is usually constant in nature. Sepsis, with an increased heart rate, increased breathing rate, fever, and confusion may occur.

Abdominal bloating is a symptom that can appear at any age, generally associated with functional gastrointestinal disorders or organic diseases, but can also appear alone. The person feels a full and tight abdomen. Although this term is usually used interchangeably with abdominal distension, these symptoms probably have different pathophysiological processes, which are not fully understood.

Pneumoperitoneum Medical condition

Pneumoperitoneum is pneumatosis in the peritoneal cavity, a potential space within the abdominal cavity. The most common cause is a perforated abdominal organ, generally from a perforated peptic ulcer, although any part of the bowel may perforate from a benign ulcer, tumor or abdominal trauma. A perforated appendix seldom causes a pneumoperitoneum.

Ogilvie syndrome Medical condition

Ogilvie syndrome is the acute dilatation of the colon in the absence of any mechanical obstruction in severely ill patients.

An acute abdomen refers to a sudden, severe abdominal pain. It is in many cases a medical emergency, requiring urgent and specific diagnosis. Several causes need immediate surgical treatment.

Abdominal x-ray

An abdominal x-ray is an x-ray of the abdomen. It is sometimes abbreviated to AXR, or KUB.

Diaphragmatic rupture Medical condition

Diaphragmatic rupture is a tear of the diaphragm, the muscle across the bottom of the ribcage that plays a crucial role in respiration. Most commonly, acquired diaphragmatic tears result from physical trauma. Diaphragmatic rupture can result from blunt or penetrating trauma and occurs in about 5% of all people with trauma.

Median arcuate ligament syndrome Medical condition

In medicine, the median arcuate ligament syndrome is a rare condition characterized by abdominal pain attributed to compression of the celiac artery and the celiac ganglia by the median arcuate ligament. The abdominal pain may be related to meals, may be accompanied by weight loss, and may be associated with an abdominal bruit heard by a clinician.

References

  1. Saber AA, Boros MJ (March 2005). "Chilaiditi's syndrome: what should every surgeon know?". Am Surg. 71 (3): 261–3. PMID   15869145.
  2. Glatter RD, April RS, Miskovitz P, Neistadt LD (2007). "Severe Recurrent Abdominal Pain: An Anatomical Variant of Chilaiditi's Syndrome". MedGenMed. 9 (2): 67. PMC   1994890 . PMID   17955121.
  3. Plorde JJ, Raker EJ (December 1996). "Transverse colon volvulus and associated Chilaiditi's syndrome: case report and literature review". Am. J. Gastroenterol. 91 (12): 2613–6. PMID   8946999.
  4. 1 2 Keles S, Artac H, Reisli I, Alp H, Koc O (June 2006). "Chilaiditi syndrome as a cause of respiratory distress". Eur. J. Pediatr. 165 (6): 367–9. doi:10.1007/s00431-005-0077-9. PMID   16489467.
  5. Walsh SD, Cruikshank JG (February 1977). "Chilaiditi syndrome". Age Ageing. 6 (1): 51–7. doi:10.1093/ageing/6.1.51. PMID   842405.
  6. 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.
  7. synd/2326 at Who Named It?
Classification
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