A Rare Case of Chilaiditi Syndrome as a Driver of Chronic Respiratory Failure

Chilaiditi sign is a rare radiographic finding demonstrating interposition of the colon between the liver and the diaphragm; Chilaiditi syndrome is the manifestation of gastrointestinal or respiratory symptoms secondary to this finding. This syndrome rarely can be associated with acute and chronic respiratory failure. We report a case of a 66-year-old woman with chronic hypercapnic and hypoxemic respiratory failure due to severe restrictive pulmonary mechanics in the setting of Chilaiditi syndrome. Imaging showed an elevated right hemidiaphragm initially concerning for hemidiaphragm paralysis; however a fluoroscopic Sniff test suggested normal diaphragm function. Despite hospitalisation for aggressive bowel decompression combined with noninvasive ventilation (NIV), this patient's chronic respiratory failure ultimately proved fatal. This case illustrates a rare presentation of Chilaiditi syndrome with chronic hypercapnic and hypoxemic respiratory failure refractory to standard management. Recognition of this entity and multidisciplinary care are essential to avoid misdiagnosis and optimise patient outcomes.