Chilaiditi's Sign: A Rare Finding in a Patient with Concurrent Liver Cirrhosis and Chronic Lymphocytic Leukemia

Abstract

Chilaiditi's sign is a rare radiological finding characterized by colonic interposition between the liver and the right hemidiaphragm. It is a cause of pseudopneumoperitoneum which is often mistaken for true pneumoperitoneum. In this article, we present the case of a 73-year-old female with a previous history of pulmonary tuberculosis, who reported to our hospital with progressive abdominal distension associated with early satiety, bipedal swelling, generalized weakness, worsening fatigue, and weight loss. Following evaluation, she was diagnosed with liver cirrhosis and chronic lymphocytic leukemia. Her chest radiograph also incidentally showed air under the right hemidiaphragm with haustral folds consistent with Chilaiditi's sign. Since she did not have signs of peritonitis, she was eventually treated for liver cirrhosis and chronic lymphocytic leukemia without undergoing any surgical intervention. This case report seeks to create awareness among clinicians about this rare radiological sign in order to prevent misdiagnosis leading to unnecessary surgical procedures.

Keywords: Chilaiditi’s sign; Chilaiditi’s syndrome; chronic lymphocytic leukemia; liver cirrhosis; pseudopneumoperitoneum.

Figure 1.

Peripheral blood smear showing small, mature-appearing lymphocytes with condensed chromatin (yellow arrow). Also present are smudge cells (red arrow).

Figure 2.

Resting 12-lead electrocardiogram showing sinus tachycardia.

Figure 3.

(A) Plain chest radiograph taken on the first day of admission. It demonstrates air under the right hemidiaphragm (yellow arrow) with the appearance of haustral folds within the air (red arrow). There is tracheal deviation to the left (blue arrow) as well as reduction of left lung volume (brown arrow). (B) Chest radiograph repeated on day 3 of admission still showing haustra within the air under the right hemidiaphragm (red arrow). This indicates the air is within the bowel lumen and not free (Chilaiditi’s sign).

Figure 4.

Endoscopic image of the patient showing grade 2 esophageal varices.