A rare cause of sudden chest pain and dyspnea

Abstract

Rationale: Chilaiditi syndrome is a rare disorder characterized by a broad spectrum of (gastro-intestinal) symptoms caused by interposition of a segment of bowel between the liver and the diaphragm. Most cases present with abdominal symptoms and the morbidity tend to increase with age. Patient concerns: Here we present a rare case of Chilaiditi syndrome. An elderly postmenopausal woman developed unresolved postoperative respiratory symptoms and chest pain. Chest auscultation revealed considerable attenuation of respiratory sounds. She showed postoperative increase in D-dimer level and sudden onset of dyspnea. Diagnoses: Considering the presence of atelectasis in the middle and lower lobes of the right lung, bedside fiberoptic bronchoscopy was performed immediately to rule out bronchial phlegm embolism. However, no phlegm embolism was found in the left lung, and a small amount of yellow–white mucus was seen in the upper lobe of the right lung. Due to external pressure, the lumen of the middle and lower lobes of the right lung was obviously narrowed. Interventions: The patient was placed in a semi-sitting position and a tube was passed through the anus to decompress the intestinal cavity; in addition, she received potassium supplementation. Outcomes: The patient's symptoms improved markedly. Chest and semi-supine abdominal plain radiographs showed enhanced lung markings, shadows in the left lower lung lobes, elevation of the right diaphragm, and small amount of pneumoperitoneum. The patient recovered after 5 days of continuous treatment and was discharged. Lessons: Emergency computed tomographic pulmonary angiography may facilitate the diagnosis of Chilaiditi syndrome, especially in the postoperative setting. Occurrence of Chilaiditi syndrome in this patient was likely associated with surgical factors. Appropriate investigations and clear identification of etiology are essential for successful treatment.

Chilaiditi Syndrome: A Case Report, Literature Review, and Proposition of a Novel Management Staging System

“…Following the classifications in Table 2 , mild cases of Chilaiditi syndrome (stage 1) should be managed medically with a high-fiber diet, laxatives or stool softeners, and antispasmodics [ 14 ]. Additionally, physical activity has been shown to be beneficial by promoting intestinal peristalsis [ 15 ]. However, moderate to severe cases (stages 2 and 3) should be worked up further with imaging scans such as gastrografin enemas, CT scans with endoluminal contrast, and colonoscopy.…”

Chilaiditi syndrome: A structural displacement in a heart failure patient

“…There were other case reports published in the British Medical Journal, CHEST, and MEDICINE [ 2 , 4 , 5 ] in which Chilaiditi syndrome mimicked heart failure symptoms with associated dyspnea. Chilaiditi's sign was seen on chest radiograph in these cases and additional heart failure workup was negative [ 5 ].…”

“…Patients are typically managed conservatively. However, in rare cases invasive surgical procedures may be indicated if the bowel is obstructed and does not respond to conservative approaches [ 4 ]. Initial management of Chilaiditi syndrome should include bed rest, intravenous fluid therapy, bowel decompression, enemas, and laxatives.…”

An Atypical Case of Chilaiditi Syndrome

“…The incidence is reported to be 0.025% to 0.28% and is four times more common in males than females [4]. Commonly associated clinical symptoms of Chilaiditi syndrome are respiratory distress, angina like chest pain, anorexia, abdominal pain, vomiting, constipation, intestinal obstruction, and volvulus [5,6].…”

“…Chilaiditi syndrome can present differently from one patient to another. Because Chilaiditi syndrome is rare, it is critical for clinicians to use radiological imaging modalities such as chest and abdominal radiographs, CT scan, and ultrasound to rule out other potential causes of pneumoperitoneum of which Chilaiditi syndrome can mimic [6,7]. Recognition of Chilaiditi syndrome can minimize unnecessary surgical intervention such as laparotomy as in this patient.…”