# Chilaiditi Sign: A Rare Radiographic Encounter and Diagnostic Exploration

## TL;DR

This case report describes a rare radiographic finding called the Chilaiditi sign and its diagnostic challenges in a patient with abdominal symptoms.

## Contribution

The paper presents a unique case highlighting the diagnostic importance of distinguishing Chilaiditi sign from pneumoperitoneum.

## Key findings

- A chest X-ray revealed the Chilaiditi sign with transverse colon interposition beneath the right hemidiaphragm.
- Contrast-enhanced CT showed a large multicystic mass adherent to the uterus, raising suspicion of malignancy.
- The case underscores the need for accurate diagnosis to avoid unnecessary investigations and optimize management.

## Abstract

This case report explores the complex diagnostic dilemma between the Chilaiditi sign and the pneumoperitoneum. The patient presented with chronic complaints of vague abdominal pain, abdominal distension, and breathlessness. A chest X-ray indicated an elevated right hemidiaphragm with transverse colon interposition, leading to the diagnosis of Chilaiditi's sign. Subsequent imaging, including abdominal ultrasound and contrast-enhanced computed tomography, revealed a large non-enhancing multilobulated multicystic mass adherent to the anterior wall of the uterus, raising suspicions of malignancy. Managed by gynecologists, the patient underwent a total abdominal hysterectomy, mass excision, and bilateral salpingo-oophorectomy. The discussion delves into Chilaiditi's sign, its historical context, and its complex pathophysiology involving intestinal, hepatic, and/or diaphragmatic components. Various anatomical and functional factors contributing to this condition are explored. This case highlights the importance of considering the Chilaiditi sign in patients with radiologic evidence of subdiaphragmatic air. It emphasizes the need for timely and accurate diagnosis to differentiate it from more severe conditions like pneumoperitoneum. Such consideration aids in optimizing management strategies and preventing unnecessary investigations.