Chilaiditi Syndrome: An Exceptional Cause of Dyspnea

Document Type

Conference Proceeding

Publication Date

10-2024

Publication Title

Chest

Abstract

INTRODUCTION: Chilaiditi syndrome refers to a rare benign medical condition in which colonic interposition happens between the liver and diaphragm (known as Chilaiditi sign radiographically) and is associated with clinical symptoms. We describe a case of a patient who presented with abdominal pain, and shortness of breath, who was found to have a Chilaiditi syndrome. CASE PRESENTATION: A 59 year old female with history of scoliosis, diverticulitis s/p Hartman's procedure complicated by anastomotic stricture, subsequent colostomy reversal, rectal stent placement requiring flexible sigmoidoscopy decompressions presented with abdominal pain, bloating, and shortness of breath. On presentation, CXR was performed which showed a dilated colonic loop up to 13 cm with elevated right hemidiaphragm, severely reduced lung volume. CT Chest showed right lower lobe collapse with dilated colon without pneumomediastinum. CT abdomen/pelvis demonstrated right lower lobe dilated colon with obstruction at the site of stents without any pneumoperitoneum. Pulmonology and colorectal surgery was consulted for management. From a pulmonary standpoint, the patient was put on non-invasive ventilator (NIV) support for acute hypoxic and hypercapnic respiratory failure. Later, She underwent colonic decompressions with excessive stool output. She had significant improvement in her symptoms following the decompression. She was discharged on 1-2L of supplemental O2 as needed. She had a pulmonary function test which showed moderate restrictive impairment. DISCUSSION: Chilaiditi is a rare and incidental finding on CXR or chest/abdominal CT scan. Laxity or absence of suspensory ligaments, along with other factors such as, congenital malpositions, chronic constipation, cirrhosis, sudden and substantial weight loss, chronic lung diseases, diaphragmatic paralysis, and multiple pregnancies, can predispose patients to Chilaiditi syndrome. Interestingly, intellectual disability, and schizophrenia are associated with anatomic variations that can result in Chilaiditi sign. In our case, the patient developed Chilaiditi syndrome likely secondary to previous abdominal surgeries, and colonoscopies. On presentation, the patient's CXR suggested possible etiologies such as pneumothorax, pneumoperitoneum, lung abscess, diaphragmatic hernia, and colonic perforation. However, chest and abdomen/pelvis CT helped in determining the diagnosis. Chilaiditi syndrome is usually a benign condition and requires conservative management. The treatment is mainly focused on targeting abdominal and respiratory symptoms, and include fluid resuscitation, nasogastric bowel decompression, and stool softeners. However, in rare circumstances it can cause severe complications including volvulus, perforation, mesenteric ischemia, and peritonitis. CONCLUSIONS: Awareness of Chilaiditi's sign is crucial while evaluating free air under the diaphragm. When free air is seen under the right diaphragm on plain abdominal film, an abdominal CT scan should be performed to differentiate between Chilaiditi syndrome and other surgical emergencies. Early recognition of Chilaiditi's syndrome in these patients may avoid inappropriate, and extreme surgical interventions in these patients.

Volume

166

Issue

4 Suppl

First Page

A4079

Last Page

A4080

Comments

Chest 2024 Annual Meeting, October 6-9, 2024, Boston, MA

DOI

10.1016/j.chest.2024.06.2477

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