![]() Chest plain film showed what appeared to be air under the right hemidiaphragm (Figure 1a). The patient was hemodynamically stable with abdominal tenderness in the right upper quadrant with focal guarding. He noted some diarrhea but had had no flatus since the night before. The day before he presented, he had fallen onto his right side while standing later that same evening, he began experiencing right upper quadrant and lower thoracic pain. Key WordsĬhilaiditi’s sign acute abdomen pneumoperitoneum: cecal bascule Morgagni’s hernia Case Description Case OneĪ 67-year-old male with a history of stroke and partial left hemiparesis presented to our facility with right upper quadrant pain. A thorough surgical exam and additional imaging will help delineate the true etiology of abdominal pain and triage patients appropriately. ConclusionĬhilaiditi’s sign can be associated with an acute abdomen. She underwent an elective laparoscopic hernia repair, which confirmed the presence of an anteromedial diaphragmatic hernia containing small bowel, colon, and omentum. An upright chest X ray revealed air under the right hemidiaphragm, and the CT scan demonstrated a large, right-sided Morgagni-type diaphragmatic hernia. The second patient was a 59-year-old female who presented with acute onset of right-sided abdominal pain. Diagnostic laparoscopy confirmed imaging findings, and he underwent an open right hemicolectomy. ![]() A CT scan revealed a cecal bascule interposed between the liver and diaphragm with concomitant acute appendicitis. He was found to have Chilaiditi’s sign on the upright chest X ray. The first patient was a 67-year-old male who presented with right upper quadrant pain. We present two cases of Chilaiditi’s sign resulting from vastly different pathologies. Chilaiditi’s sign can be mistaken for pneumoperitoneum and can be alarming in the setting of an acute abdomen. Chilaiditi’s sign is a rare radiologic sign where the colon or small intestine is interposed between the liver and the diaphragm.
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