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Chilaiditi Sign
By Borko Kereshi, MSIII
The case
• History: 58 yo female with right upper pole kidney mass– Found to be Renal Cell Carcinoma– Surgical history of a Roux-en-Y gastric
• There was an incidental finding…
What’s going on?
How does this happen?
• Colon can roll over on its edge, separating the liver from the anterior abdominal wall– Causes the liver to appear smaller when percussed
• Internal displacements due to irregular intestinal adhesions can arise during intra-uterine or extra-uterine life
• Mobility of the entire ascending colon secondary to defective fusion allows the right colon to be located anywhere in the abdomen including beneath the right diaphragm
Chilaiditi’s Sign
• usually asymptomatic interposition of the bowel (usually hepatic flexure of the colon) between the liver and the (right) hemidiaphragm
• Seen in 0.1-0.25% of chest x-rays • Not to be mistaken for pneumoperitoneum
Chilaiditi’s Sign, contributing factors
– Absence of normal suspensory ligaments of the transverse colon
– Abnormality or absence of the falciform ligament – Redundant colon, as might be seen with chronic
constipation or in bedridden individuals – Aerophagia – Paralysis or eventration of the right
hemidiaphragm – Patients with chronic lung disease, cirrhosis and
ascites
Coronal view
Coronal view
Sagittal View
Renal Cell carcinoma
References
• Samuel Wilks, Walter Moxon. Lectures on Pathological Anatomy. 2nd ed. Philadelphia, Lindsay and Blakiston
• learningradiology.com• Balthazar, Emil J. Congenital Positional
Anomalies of the Colon: Radiographic Diagnosis and Clinical Implications. Gastrointestinal Radiology. 1977.
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