Chilaiditi sign

Dr Craig Hacking and Dr Vikas Shah et al.

Chilaiditi sign refers to the interposition of bowel, usually colon, between the inferior surface of the right hemidiaphragm and the superior surface of the liver. It may be misinterpreted as a true pneumoperitoneum resulting in unnecessary further investigations and/or therapy (so-called pseudopneumoperitoneum). The presence of pain associated with and attributed to the sign is termed Chilaiditi syndrome.

Features that suggest Chilaiditi sign include:

  • gas between liver and diaphragm
  • haustra within the gas suggesting that it is within the bowel and not free

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 air. 

Asymptomatic patients with Chilaiditi sign do not require further imaging or treatment.

It is named after Demetrius Chilaiditi (1883-1975) 1, Greek radiologist who described the radiographic findings in 1910 whilst working in Vienna, Austria 2. Although the first description of interposition of colon between the liver and the right hemidiaphragm was published by Cantini in 1865 2.

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Article information

rID: 59917
Section: Signs
Synonyms or Alternate Spellings:
  • Chilaiditi's sign

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Cases and figures

  • Case 1: Chilaiditi sign
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  • Case 2: Chilaiditi sign and diaphragmatic eventration
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