Chilaiditi syndrome as a cause of respiratory distress

Congenital partial diaphragmatic eventration presenting with Chilaiditi's sign: a case report

BACKGROUND

Chilaiditi's sign is an incidental radiographic finding, associated with intestinal disposition located between liver and right diaphragm. It is considered as an acquired rather than a congenital condition and the prevalence ranges from 1.18% to 2.4% according to recent adult retrospective studies. The aspects of this rare entity with regards to a 7-month-old male initially misdiagnosed as diaphragmatic hernia is discussed.

CASE PRESENTATION

A 4-month-old Caucasian male was misdiagnosed with a congenital diaphragmatic hernia owing to previous hospitalization with complaints of respiratory tract infection. On admission 3 months later, he was free of any signs and symptoms of intestinal obstruction or respiratory distress. Thorax computed tomography revealed Chilaiditi's sign. A diagnostic laparoscopy was regarded necessary to evaluate the anatomical details. The most prominent finding was the lack of muscle fibers and almost transparent appearance of the medial aspect of the partially eventrated right hemidiaphragm. Owing to delicate anatomical presentation, diaphragmatic plication was considered hazardous. The patient is doing well and under follow-up.

CONCLUSIONS

It is obvious that Chilaiditi's sign is not always a completely incidental finding of no consequence, and may indicate an underlying congenital diaphragmatic pathology, clearly defined by laparoscopic evaluation in this case.

Chilaiditi syndrome in pediatric patients - Symptomatic hepatodiaphragmatic interposition of colon: A case report and review of literature

BACKGROUND

Chilaiditi syndrome is a rare disorder characterized by the hepatodiaphragmatic interposition of the intestine.

CASE SUMMARY

Here we report a case of a 12-year-old male who was admitted to the pediatric intensive care unit secondary to abdominal pain and severe respiratory distress. He was treated conservatively but the symptoms persisted requiring a surgical approach. While there have been several cases of Chilaiditi syndrome reported in adults, there is a scarcity of cases reported in the pediatric population. Our review of the literature found only 30 pediatric cases, including our reported case, with Chilaiditi syndrome, 19 (63%) of which were male. The median age of diagnosis was 4.5 years old with an interquartile range of 2.0-10.0 years. In our review, we found that the most common predisposing factors in children are aerophagia (12/30 cases) and constipation (13/30 cases). Ninety percent of the cases presented with complete intestinal interposition, in 100% of which, the colon was involved. Three of the 30 cases were associated with volvulus.

CONCLUSION

In the pediatric population, conservative (21/30 cases) and surgical (8/30 cases) treatment approaches have produced satisfactory outcomes for all the patients, regardless of approach.

Duchenne muscular dystrophy with platypnea-orthodeoxia from Chilaiditi syndrome

INTRODUCTION

Chilaiditi syndrome is a rare pathophysiology in which the colon or other organs are interposed between the diaphragm and liver, and respiratory or digestive symptoms sometimes manifest. Although there have been some cases of Chilaiditi syndrome complicating neuromuscular disorders, none have described resulting respiratory or digestive symptoms.

CASE PRESENTATION

Our patient was a 20-year-old man with DMD who had been receiving noninvasive positive-pressure ventilation during the night. He experienced respiratory distress when changing from a supine to sitting position. Ventilator adjustment did not relieve the respiratory distress. Abdominal computed tomography revealed marked constipation and interposition of the transverse colon between the diaphragm and liver, indicating Chilaiditi syndrome. The right side of the diaphragm was elevated by the interposed transverse colon when the respiratory distress was present on chest radiograph, but not when symptoms were absent. The patient was diagnosed with platypnea-orthodeoxia attributed to Chilaiditi syndrome. The respiratory distress was improved by the relief of constipation, in addition to the usage of the ventilator throughout the day.

CONCLUSION

The rare symptoms and pathophysiology of DMD complicated by Chilaiditi syndrome are reported and discussed herein.

Treatment of Chilaiditi syndrome using laparoscopic surgery

Chilaiditi syndrome is defined as the interposition of the bowel between the liver and right diaphragm. It is a rare disease and may be difficult to diagnose and manage. Treatment for asymptomatic patients with Chilaiditi is usually conservative and does not require surgical intervention, but surgery may be necessary if conservative treatment fails. This report describes a rare case of Chilaiditi syndrome causing small bowel obstruction and corrected using laparoscopic surgery.

Chilaiditi Syndrome in Two Cases Presented with Respiratory Distress Symptoms

Chilaiditi syndrome is a rare syndrome known hepatodiaphramatic interposition of as colon or small intestine. As this pathology is usually asymptomatic, it is incidentally identified in adults and rarely reported in children. Herein, two children cases are presented with respiratory distress, who were diagnosed as Chilaiditi syndrome by chest radiography.

Coexistence of pneumothorax and Chilaiditi sign: a case report

We present a case of 50 year old male patient with coexistence of Pneumothorax and Chilaiditi sign. Chilaiditi sign is an incidental radiographic finding of a usually asymptomatic condition in which a part of intestine is located between the liver and diaphragm; however, the term "Chilaiditi syndrome" is used for symptomatic hepatodiaphragmatic interposition. The patient had no symptoms of abdominal pain, constipation, diarrhea, or emesis. Incidentally, Chilaiditi sign was diagnosed on chest radiography. Pneumothorax is defined as air in the pleural space. Pneumothoraces are classified as spontaneous or traumatic. Spontaneous pneumothorax is labelled as primary when no underlying lung disease is present, or secondary, when it is associated with pre-existing lung disease. Our case is the rare in the literature indicating the coexistence of Chilaiditi sign and pneumothorax.

Radiographic look-alikes: distinguishing between pneumoperitoneum and pseudopneumoperitoneum

BACKGROUND

Air under the diaphragm seen on plain radiograph usually signifies a perforated viscus. This represents a surgical emergency and an immediate consult with the surgeon. However, not all air under the diaphragm seen on plain radiograph represents a surgical emergency.

OBJECTIVES

This article will present two cases with air under the diaphragm, but with different diagnoses and management. The first case is an example of pneumoperitoneum from a perforated viscus. The second case is an example of pseudopneumoperitoneum from Chilaiditi syndrome, which will be discussed.

CASE REPORTS

The first case is a 45-year-old woman who presented with bloating, nausea, and vomiting after being diagnosed with diverticulitis 4 days before evaluation. The patient was noted to be febrile and tachycardic. A chest radiograph was obtained, which showed air under the diaphragm. A surgeon was consulted who performed a laparotomy on the patient. Patient was diagnosed with a perforated viscus from a sigmoid diverticulitis. The second case is a 68-year-old woman who presented with right-sided abdominal pain, cough, nausea, and vomiting. A chest radiograph showed possible free air under the diaphragm. A computed tomography scan of the abdomen showed Chilaiditi syndrome, large bowel transposed between the liver and the diaphragm, but no free air. The patient was treated symptomatically and discharged home.

CONCLUSION

It is important for physicians to be able to distinguish pneumoperitoneum and pseudopneumoperitoneum to allow proper diagnosis and treatment.