Chilaiditi’s sign and syndrome: rare conditions but diagnostically important in Pediatrics. Clinical Cases

Abstract

Albeit scarce, bowel interposition between diaphragm and liver, Chilaiditi's sign or syndrome (with or without gastrointestinal symptoms), are a major clinical condition given the possibilities of differential diagnosis, such as pneumoperitoneum, diaphragmatic hernia and subphrenic abscess.

Objective: to report the cases of two preschool patients with Chilaiditi´s sign and syndrome, as well as to highlight the importance of this clinical condition, in relation to the possibilities of confusion and differential diagnoses.

Clinical Cases:  Case 1: boy preschooler evaluated by respiratory disease without abdominal symptoms. Thorax X-ray shows Left retrocardiac infiltrates and Air in right subdiagramatic region. Previous radiographies shows the same image. He was diagnosed with Chilaiditi sign associated with pneumonia, he managed with antibiotics and discharged. Case 2: feminine preschooler, evaluated by abdominal distention and constipation. Thorax X-ray, taken before because of respiratory disease, shows bowel interposition between diaphragm and liver. barium enema confirmed the findings. Blood exams were normal. It concluded Chilaiditi's syndrome. She received medical treatment with favorable evolution.

Conclusion: These cases highlight the importance of this clinical condition that, despite being infrequent, constitutes a diagnostic challenge in the emergency services.