International Journal of Clinical & Medical Images

Clinical Image:

Chest X-ray obtained for an 83 year old female during chest pain evaluation demonstrated air beneath an elevated right hemidiaphragm with haustral markings (Figures 1 and 2). The patient did not have any abdominal pain at that time. This finding was seen on numerous prior studies. It represents interposition of the colon between the liver and right diaphragm, which is consistent with Chilaiditi’s sign. Chilaiditi’s sign was first described by a Greek radiologist, Demetrius Chilaiditi in 1910. This asymptomatic radiographic sign is used to describe the interposition of the colon between the liver and diaphragm. It occurs in about 0.025-0.28% of the general population. It tends to occur more frequently in adults and males. The etiology for Chilaiditi’s sign is unknown, however risk factors include increased space between the liver and diaphragm. 1 Treatment consists of conservative management with supportive care. When Chilaiditi’s sign is associated with abdominal pain, it is known as Chilaiditi’s Syndrome.