Chilaidity Sign

Candra Harmindasatya
 Male, 57 Years Old
• Referred from :
Otolaryngology Outpatient Clinic
• Clinical Information :
Mass of Intranasal Cavity
• Asked for :
Chest X-Ray PA Projection
28/07/2020
History Taking
Patient came to otolaryngology clinic complaining of lump in his left nose
since 2 years, getting bigger, now also obstructed his right nose, rainy nose
(+) white to yellowish mucus, no blood, anosmia (+), sometimes pain,
difficult to swallow food, able to drink

14/08/2020 Enhacing solid mass in right and left nasal cavity with those infiltrating detail
Unenhanced and could be could be malignant sinonasal mass (AJCC staging 8th ed 2018 :
Enhanced Head T3N2MX)
MSCT Subcentimeter lymhpnode in right upper jugular, right and left mid jugular
Bilateral mastoiditis
Schmorl node in superior endplate

01/09/2020 Extra axial solid mass with size +/- 8,6 x 4,07 x 4,7 cm in right and left nasal
Unenhanced and cavity with those infiltrating detail could be malignant sinonasal mass (AJCC
Enhanced Head MRI staging 8th ed 2018 : T3N2MX)
Bilateral frontalis, maxillaris, sphenoidalis, ethmoidalis sinusitis, bilateral
mastoiditis (left mastoid is worst)
Subcentimeter lymhpnode right left upper and mid jugular
There is no extension to intracranial
Hypoplasia segmen A1 Right ACA

23/09/2020 Patient visited otolaryngology clinic controling for the further medical
evaluation and asked for Chest X-ray PA Projection
CHEST X-RAY PA PROJECTION
CHEST X-RAY PA PROJECTION
• Heart : size and shape are normal
• Lung : there is no infiltrat / nodule, there
is hiperareation in both lungs
• Right and left costophrenis sinus are
sharp
• Right and left hemidiaphragm are looks
good
• Trakhea in the middle
• There is no osteolitic/osteoblastic
process
• Soft tissue looks good
• There is appearence of bowel gas at
right subdiaphragm
• There is interpotition of liver by colon at
right subdiaphragm
Conclution
• There is no metastastic process in lung or visualized bones
• Interpotition of liver by colon at right subdiaphragm leads to Chilaidity
sign
• Hyperaerated lung
• Heart is normal
Chilaidity
Chilaidity Syndrome
• Chilaiditi syndrome is the anterior interposition of the colon to the liver
reaching the under-surface of the right hemidiaphragm with associated
upper abdominal pain; it is one of the causes of 
pseudopneumoperitoneum.
• Colonic gas in this position may be misinterpreted as true 
pneumoperitoneum resulting in further imaging, investigation, and
treatment that is not required.
• Pain distinguishes Chilaiditi syndrome from asymptomatic colonic
interposition, which is termed as Chilaiditi sign. This is by virtue of the fact
that syndrome is a collection of signs and symptoms. History and
etymology
• It is named after Demetrius Chilaiditi (1883-1975) 4, Greek radiologist who
described the radiographic findings in 1910 3 whilst working in Vienna,
Austria. Although the first description of the interposition of colon
between the liver and the right hemidiaphragm was published by Cantini
in 1865 4
Chilaidity Syndrome
• Features that suggest a Chilaiditi syndrome (i.e. Chilaiditi sign)
include:
• gas between the liver and diaphragm
• haustra within the gas suggesting that it is within the bowel
and not free
• CT
• If there is a clinical suspicion of abdominal visceral perforation
and plain radiographic appearances are unclear, abdominal CT
can be performed to clarify whether there is
pneumoperitoneum.
• CT can clearly demonstrate the presence of interposed colonic
loops between the right hemidiaphragm and liver with no free
intraperitoneal
Chilaidity Syndrome
• Features that suggest a Chilaiditi syndrome (i.e. Chilaiditi sign)
include:
• gas between the liver and diaphragm
• haustra within the gas suggesting that it is within the bowel
and not free
Thank You