Images in the Medical Sciences| Volume 360, ISSUE 1, P79-80, July 2020

Chilaiditi Syndrome Secondary to Hepatic Migration in a Patient With Bilateral Diaphragmatic Palsy

      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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