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Chilaiditi Sign

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?.

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Chilaiditi Sign

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  1. Chilaiditi Sign By BorkoKereshi, MSIII

  2. 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…

  3. What’s going on?

  4. 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

  5. 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

  6. 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

  7. Coronal view

  8. Coronal view

  9. Sagittal View

  10. Renal Cell carcinoma

  11. 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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