Chilaiditi Syndrome: A Case Report and Review of the Literature

The Chilaiditi sign refers to the interposition of a bowel segment, most commonly the colon, between the liver and the right hemidiaphragm. The term Chilaiditi syndrome is reserved for cases in which this radiographic finding is accompanied by clinical manifestations that can reasonably be attributed to it. Respiratory or thoracic presentations are uncommon. We report the case of an 80-year-old woman with hypertension and knee osteoarthritis who presented with a persistent dry cough, right-sided lower chest pain, and progressive fatigue, without active gastrointestinal symptoms at presentation. The pleuropulmonary examination was unremarkable, oxygen saturation was 97% on room air, and laboratory testing showed no significant abnormality, with a C-reactive protein level of 3 mg/L. Chest radiography demonstrated apparent elevation of the right hemidiaphragm and a right subdiaphragmatic lucency containing colonic haustral markings. Contrast-enhanced thoracoabdominal computed tomography confirmed interposition of the hepatic flexure and transverse colon between the liver and the right hemidiaphragm, without digestive complications or associated pleuropulmonary abnormalities. CT therefore confirmed an uncomplicated Chilaiditi sign. In the absence of another thoracic abnormality that could explain the symptoms and given their complete resolution following conservative treatment, Chilaiditi syndrome was considered the most likely diagnosis. However, a causal relationship with the cough could not be established with certainty, particularly because pulmonary function testing was not performed. The Chilaiditi sign should be considered when a right subdiaphragmatic lucency containing colonic haustral markings is identified. CT confirms bowel interposition, assesses for complications, and helps exclude the main radiographic differential diagnoses. In uncomplicated cases, management is conservative, and clinical follow-up with reassessment if symptoms recur is appropriate.