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.