Hepatodiaphragmatic interposition of the intestine (Chilaiditi's syndrome)

Hepatodiaphragmatic interposition of the intestine (HDI) is a common radiological finding in the normal population of Iran compared to Western countries (0.22% vs 0.02%). A high incidence of this finding was observed in patients with chronic lung disease (2.7%) and in women near term pregnancy (2.0%). A striking incidence of 22% was observed in patients with post-necrotic cirrhosis. Probable contributing factors are: (a) a redundant bowel with increased mobility, (b) an enlarged lower thoracic outlet in conditions such as pregnancy, emphysema, and cirrhosis with ascites, (c) an atrophic liver of post-necrotic cirrhosis, which leaves adequate space for intrusion of adjacent bowel segments. HDI of the bowel is generally an asymptomatic condition and its finding on a chest radiograph suggests atrophic cirrhosis of the liver.