A 72-year-old male presented to the Emergency Department for evaluation of worsening right upper quadrant (RUQ) abdominal pain. The patient had suffered from chronic RUQ discomfort for the past several months; his pain became significantly worse, with intermittent cramping, prompting the ED visit. In addition, the patient had new-onset constipation over the past several weeks. His medical history was most notable for bilateral diaphragmatic palsy of unclear etiology and ischemic heart disease. His vital signs were stable and physical examination was only significant for RUQ tenderness to deep palpation. Blood work, including liver function tests, was unremarkable. A chest X-ray demonstrated small lung volumes and bilateral hemidiaphragmatic elevation. The transverse colon was thought to be interposed between the right hemidiaphragm and the liver (black arrow), consistent with Chilaiditi sign (Figure 1).
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Published online: March 18, 2020
Accepted: March 11, 2020
Received: December 23, 2019
Grants or industrial support: None.
Conflicts of interest: All authors have no conflict of interest. BKS and AB were directly involved in patient care. All authors participated in the preparation of the manuscript.
© 2020 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.