Chilaiditi syndrome. An uncommon cause of crampy, upper abdominal pain.
A 69 year old man with hypertension, mild (stage II) chronic kidney disease and uncomplicated type B aortic dissection presented to the emergency service with a 2week history of colicky upper abdominal pain and nausea. His symptoms had progressively worsened with shortness of breath that was exacerbated with activity. At presentation, he denied fever, vomiting or weight loss. The patient appeared uncomfortable. Upon physical examination, his abdomen was distended, the right hypochondrium revealed mild tenderness with tympanic percussion tones. Laboratory investigations were noncontributory with the exception of a mild leukocytosis of 10,900/mL and elevated ESR of 23 mm/h. A chest radiograph was obtained (Figure 1) It suggested the presence of an air filled distended bowel tract within the right subphrenic space, with the superior liver profile depressed below the level of the left hemidiaphragm (Figure 1, panel A) Computed tomography (Figure 2) revealed no free air, confirming the presence of isolated pseudopneumoperitoneum, due to colonic interposition between the liver and diaphragm (Chilaiditi's sign) The patient was treated conservatively and observed with analgesia, intravenous fluids and bowel decompression to which he responded favorably. He was well and discharged home 4 days later. The Official Journal of the Mexican Association of Hepatology, the Latin American Association for Study of the Liver and the Canadian Association for the Study of the Liver
Annals of hepatology