Chilaiditi Syndrome: A Rare Case of Chest Pain due to Colonic Interposition

We present an unusual case of Chilaiditi syndrome that manifests under the guise of multiple systemic signs and symptoms. An 81-year-old female patient with a history of coronary artery disease and hypothyroidism presented to emergency department (ED) with chest heaviness associated with nausea, shortness of breath, diffuse abdominal pain and constipation. Her symptoms were similar to the previous episode of ST-segment elevation myocardial infarction. The clinical team ruled out acute coronary syndrome based on electrocardiogram (EKG) and troponin levels. On further testing, CT of the abdomen revealed the interposition of colon on the dome of diaphragm consistent with Chilaiditi sign. The patient was diagnosed with Chilaiditi syndrome based on the characteristic radiological finding and the symptomatic presentation. Conservative management with bowel rest and laxative bowel regimen resolved her symptoms without further complications. A high index of suspicion is required for the early diagnosis and can prevent further complications and mitigate the need for laparoscopic intervention.