Chilaiditi syndrome: A structural displacement in a heart failure patient

Abstract

Background Chilaiditi's sign is often found incidentally on chest or abdominal radiograph and can be accompanied by clinical symptoms such as abdominal pain, gastrointestinal complications, and less commonly associated with dyspnea. Case presentation In this interesting case, we discover lingering dyspnea in our 79 year old male with a past medical history of asthma and heart failure with preserved ejection fraction admitted for acute heart failure exacerbation with reduced ejection fraction along with a new incidental finding of Chilaiditi's sign on chest radiograph. Patient received optimal diuretics and guideline-directed medical treatment for heart failure exacerbation, but mild dyspnea with pleuritic chest pain persisted. Dyspnea with pleurisy was likely attributed to a structural anatomical defect (Chilaiditi's sign) that can be picked up on imaging. Conclusion Chilaiditi syndrome can be an incidental cause of ongoing persistent dyspnea, and if symptoms are severe, intervention can be warranted for symptomatic resolution. Learning objective Chilaiditi syndrome should be considered as a possible diagnosis among patients with a history of heart failure and incidental Chilaiditi's sign on chest radiographic imaging who suffer from persistent dyspnea and pleurisy despite optimal diuretics and guideline-directed medical treatment.

Chilaiditi’s Syndrome Mimicking Crohn’s

“…Misdiagnosis or failure to include Chilaiditi's sign or syndrome as a differential can result in the administration of medications with high adverse effect profiles or invasive procedures without treating the underlying issue. This is in direct opposition to an initial low-cost conservative approach used for Chilaiditi's syndrome such as bed rest, intravenous fluids, enemas, and laxatives [1]. Expensive surgical interventions requiring the removal of a portion of the colon such as transverse colectomy or right-sided colectomy are only performed once conservative methods do not alleviate symptoms.…”

“…Chilaiditi's sign (colonic interposition) is a rare anomaly that is incidentally seen on chest or abdominal radiographs, with an estimated incidence of 0.025-0.28% [1]. Chilaiditi's radiographic sign is due to an abnormally located portion of the colon that is interposed in between the liver and the diaphragm.…”