Chilaiditi's sign

Tzimas, Thomas; Baxevanos, Gerasimos; Akritidis, Nikolaos

doi:10.1016/s0140-6736(09)60486-4

Cited by 10 publications

(7 citation statements)

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“…While the presence of basal pulmonary infiltrates and/or pleural effusion should be well recognized as an indirect evidence of a subdiaphragmatic infection [ 15 ], this was not appreciated in our patient’s case. As far as the missed diagnosis of the right subphrenic abscess is concerned, we can only argue that its air component had likely been mistaken for the hepatic flexure as in Chilaiditi’s syndrome, despite the absence of austral folds [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Perforated duodenal ulcer presenting with a subphrenic abscess revealed by plain abdominal X-ray films and confirmed by multi-detector computed tomography: a case report

et al. 2013

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IntroductionPeptic ulcer disease is still the major cause of gastrointestinal perforation despite major improvements in both diagnostic and therapeutic strategies. While the diagnosis of a perforated ulcer is straightforward in typical cases, its clinical onset may be subtle because of comorbidities and/or concurrent therapies.Case presentationWe report the case of a 53-year-old Caucasian man with a history of chronic myeloid leukemia on maintenance therapy (100mg/day) with imatinib who was found to have a subphrenic abscess resulting from a perforated duodenal ulcer that had been clinically overlooked. Our patient was febrile (38.5°C) with abdominal tenderness and hypoactive bowel sounds. On the abdominal plain X-ray films, a right subphrenic abscess could be seen. On contrast-enhanced multi-detector computed tomography, a huge air-fluid collection extending from the subphrenic to the subhepatic anterior space was observed. After oral administration of 500cm3 of 3 percent diluted diatrizoate meglumine, an extraluminal leakage of the water-soluble iodinated contrast media could then be appreciated as a result of a perforated duodenal ulcer. During surgery, the abscess was drained and extensive adhesiolysis had to be performed to expose the duodenal bulb where the ulcer was first identified by methylene blue administration and then sutured.ConclusionsWhile subphrenic abscesses are well known complications of perforated gastric or duodenal ulcers, they have nowadays become rare thanks to advances in both diagnostic and therapeutic strategies for peptic ulcer disease. However, when peptic ulcer disease is not clinically suspected, the contribution of imaging may be substantial.

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Section: Discussionmentioning

confidence: 99%

Perforated duodenal ulcer presenting with a subphrenic abscess revealed by plain abdominal X-ray films and confirmed by multi-detector computed tomography: a case report

et al. 2013

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“…This radiographic entity, known as Chilaiditi sign, shows evidence of asymptomatic colonic interposition between the liver and right hemidiaphragm. [7][8] …”

Section: Figurementioning

confidence: 99%

Extracardiac Uptake on Myocardial Perfusion Imaging in a Patient With Diaphragmatic Paralysis and Chilaiditi's Sign

Tamam

Tamam²,

Yldrm³

2010

Clinical Nuclear Medicine

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We present a rare case of extracardiac activity in right hemitorax secondary to the Chilaiditi sign and diaphragmatic paralysis due to right hemiplegia identified incidentally during myocardial perfusion scintigraphy. A 77-year-old man with right hemiplegia suspected of having ischemic heart disease, was admitted for myocardial perfusion scintigraphy studies. On raw data images, intense bowel uptake in the right hemithorax was visualized. Chest radiography and CT images of the patient were evaluated and Chilaiditi sign was found. This sign is a relatively rare condition with an incidence ranging between 0.025% and 0.28%, considered as a normal variant. REFERENCES1. Vijayakumar V, Gupta R, Rahman A. Pathologic extracardiac uptake of Tc-99m tetrofosmin. J Nucl Cardiol. 2005;12:473-475. 2. Slavin JD Jr, Engin IO, Spencer RP. Retrocardiac uptake of Tc-99m sestamibi: manifestation of a hiatal hernia. Clin Nucl Med. 1998;23:239 -240. 3. Gratz S, Kempke B, Kaiser W, et al. Tumor uptake during myocardial perfusion scintigraphy. Nucl Med Commun. 2008;29:963-969. 4. Gedik GK, Ergün EL, Aslan M, et al. Unusual extracardiac findings detected on myocardial perfusion single photon emission computed tomography studies with Tc-99m sestamibi. Clin Nucl Med. 2007;32:920 -926. 5. Spieth ME, Kasner DL, Bull MP. diaphragmatic paralysis with an elevated hemidiaphragm masquerading as lung carcinoma found during myocardial perfusion imaging. Clin Nucl Med. 2002;27:903-904. 6. Jones SE, Aziz K, Yasuda T, et al. Importance of systematic review of rotating projection images from Tc-99m-sestamibi cardiac perfusion imaging for noncardiac findings. Nucl Med Commun. 2008;29:607-613. 7. Tzimas T, Baxevanos G, Akritidis N. Chilaiditi's sign. Lancet. 2009;373:836. 8. Haddad CJ, Lacle J. Chilaiditi's syndrome. A diagnostic challenge. Postgrad Med. 1991;89:249 -250.

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“…Although the bowel haustra and plicae circulares are clearly evident in our radiographs, in instances where there is less bowel insufflation, the crescentic radiolucency overlying the liver can give the impression of free air under the diaphragm or a subphrenic abscess, potentially resulting in unnecessary surgical intervention [3][4][5]. Computed tomography is the imaging of choice for the hemodynamically stable patient in this situation [4,5].…”

mentioning

confidence: 93%

Incidental finding of Chilaiditi’s sign in an elderly individual with sarcopenia

et al. 2015

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Chilaiditi's sign

Cited by 10 publications

References 0 publications

Perforated duodenal ulcer presenting with a subphrenic abscess revealed by plain abdominal X-ray films and confirmed by multi-detector computed tomography: a case report

Perforated duodenal ulcer presenting with a subphrenic abscess revealed by plain abdominal X-ray films and confirmed by multi-detector computed tomography: a case report

Extracardiac Uptake on Myocardial Perfusion Imaging in a Patient With Diaphragmatic Paralysis and Chilaiditi's Sign

Incidental finding of Chilaiditi’s sign in an elderly individual with sarcopenia

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