E-ISSN 1858-8360 | ISSN 0256-4408
 

Case Report 


SUDANESE JOURNAL OF PAEDIATRICS

2018; Vol 18, Issue No. 2

CASE REPORT

A rare radiological finding in an infant with respiratory distress

Maria Gogou (1), Andreas Giannopoulos (1), Katerina Haidopoulou (1)

(1) Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, University General Hospital AHEPA, Thessaloniki, Greece

Correspondence to:

Maria Gogou

Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, University General Hospital AHEPA, Thessaloniki, Greece.

Email: mariaangogou [at] gmail.com

Received: 15 March 2018 | Accepted: 11 December 2018

How to cite this article:

Gogou M, Giannopoulos A, Haidopoulou K. A rare radiological finding in an infant with respiratory distress. Sudan J Paediatr. 2018;18(2):61–63.

https://doi.org/10.24911/SJP.106-1521149016


ABSTRACT

We report the case of an infant who presented with respiratory distress at the Emergency Department. A chest radiograph showed interposition of colon loops between the right hemidiaphragm and liver, while abdominal and thoracic ultrasound examinations were normal. The aforementioned radiological finding was considered to be Chilaiditi’s sign. This sign usually presents as an incidental radiological finding and may be mistaken for a pneumoperitoneum or a diaphragmatic hernia. Clinicians’ familiarity with rare radiological signs is necessary.


KEYWORDS:

Chilaiditi’s sign; Radiology; Child; Chest radiograph.


INTRODUCTION

Imaging techniques constitute a helpful tool for clinicians, as they can facilitate diagnosis and pertinent management. A chest radiograph should be systematically and symmetrically checked so that potentially important abnormalities are not missed [1]. Our objective is to shed more light into a rare radiological condition, Chilaiditi’s sign, which may confuse clinicians. Chilaiditi’s sign was first defined in 1910 by the Greek radiologist Demetrius Chilaiditi in three asymptomatic cases. It usually presents as an incidental radiological finding in the context of investigations for other disorders [2].


CASE REPORT

We describe an 8-month-old male infant who was admitted to the Emergency Department due to respiratory distress since 3 days. Clinical evaluation revealed the respiratory rate of 64/minute (normal values for age: <50/minute), intercostal retractions, crepitant rales, and SpO2 88%–89% in room air. The rest of the physical examination showed normal findings. Medical history was unremarkable except for incomplete immunization status. Administration of humidified oxygen and nebulized bronchodilators was initiated. A common laboratory screening test was requested and a chest X-ray was performed which showed interposition of colon loops between the right hemidiaphragm and liver. The interposed colon portion was distended with air (Figure 1). The position of radiolucency did not change when the patient was placed in the left lateral decubitus position. Our patient underwent thoracic and abdominal ultrasound which revealed normal findings. The aforementioned radiographic finding is a characteristic of Chilaiditi’s sign. The infant’s clinical status gradually improved; significant levels of IgA antibodies against Bordetella pertussis were identified in serum, while B. pertussis DNA was detected by Polymerase Chain Reaction (PCR) in the nasal specimen. Therefore, our patient received clarithromycin orally for 14 days and was finally discharged home.

Figure 1 - Postero-anterior chest X-ray demonstrating right subdiaphragmatic air (arrows) with colon loops.


DISCUSSION

Chilaiditi’s sign is defined as the radiographic evidence of colonic interposition between the liver and the diaphragm or abdominal wall. Its frequency ranges between 0.25% and 0.28% and increases with age [2]. Differential diagnoses include pneumoperitoneum, diaphragmatic hernia, volvulus, intussusceptions, and ischemic bowel [3]. Risk factors for this condition include chronic constipation, ascites, phrenic nerve injury, and excessive aerophagia [4]. Respiratory distress has also been reported as a predisposing factor, as it happened in our case [5,6]. Physical examination and medical history significantly contribute to diagnosis, as computed tomography is not always available in a primary care setting [3].

In some circumstances, Chilaiditi’s sign is accompanied by symptoms, ranging from mild abdominal pain to acute bowel obstruction. This condition is known as Chilaiditi’s syndrome and requires appropriate management. More specifically, Chilaiditi syndrome is initially managed conservatively with rest, fluid therapy, or laxatives administration. Surgical intervention is usually indicated in patients who do not respond to the aforementioned measures or when severe complications occur (e.g., volvulus, perforation) [711]. There is also recent literature evidence that Chilaiditi’s syndrome may be intermittent in nature with resolutions and recurrences and, therefore, some authors suggest regular and long-term follow-up of patients who were conservatively managed [12].


CONCLUSION

In conclusion, in a radiograph, there are areas that can be easily misinterpreted. Our case reminds of a rare radiographic entity and underscores the need for clinicians’ familiarity with normal and abnormal radiographic findings so that unnecessary investigations and interventions are avoided.


REFERENCES

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  2. Erdem SB, Nacaroğlu HT, Karkıner CŞÜ, Alper H, Can D. Chilaiditi syndrome in two cases presented with respiratory distress symptoms. Turk Thorac J. 2015;16:97–100. https://doi.org/10.5152/ttd.2014.4063
  3. Teoh SW, Mimi O, Poonggothai SP, Liew SM, Kumar G. Pneumoperitoneum or Chilaiditi’s sign. Malays Fam Physician. 2016;11:22–4.
  4. Joo YE. Chilaiditi’s sign. Korean J Gastroenterol. 2012;59:260–1. https://doi.org/10.4166/kjg.2012.59.3.260
  5. Morais R, Lopes P, Macedo G. An unexpected abdominal radiographic finding: Chilaiditi sign. GE Port J Gastroenterol. 2018;25:52–3. https://doi.org/10.1159/000477763
  6. Kapoor K, Saha A, Dubey NK. Chilaiditi’s sign in a child with nephrotic syndrome. Clin Exp Nephrol. 2013;17:589. https://doi.org/10.1007/s10157-012-0761-9
  7. Hussain S, Hussain S, Hussain S. Chilaiditi syndrome-What’s air doing there? J Emerg Med. 2018;55:131–2. https://doi.org/10.1016/j.jemermed.2018.07.022
  8. Gad MM, Al-Husseini MJ, Salahia S, Saad AM, Amin R. Chilaiditi syndrome—a rare case of pneumoperitoneum in the emergency department: a case report. J Med Case Rep. 2018;12:263. https://doi.org/10.1186/s13256-018-1804-y
  9. Evrengül H, Yüksel S, Orpak S, Özhan B, Ağladıoğlu K. Chilaiditi syndrome. J Pediatr. 2016;173:260. https://doi.org/10.1016/j.jpeds.2016.02.060
  10. Blevins WA, Cafasso DE, Fernandez M, Edwards MJ. Minimally invasive colopexy for pediatric Chilaiditi syndrome. J Pediatr Surg. 2011;46:33–5. https://doi.org/10.1016/j.jpedsurg.2010.11.039
  11. Van Den Heede K, Van Slycke S. The Chilaiditi syndrome: another Greek tragedy? Case report and short review of literature. Acta Chir Belg. 2014;114:352–4. https://doi.org/10.1080/00015458.2014.11681041
  12. Kapania EM, Link C, Eberhardt JM. Chilaiditi syndrome: a case report highlighting the intermittent nature of the disease. Case Rep Med. 2018;2018:3515370. https://doi.org/10.1155/2018/3515370


How to Cite this Article
Pubmed Style

Gogou M, Giannopoulos A, Haidopoulou K. A rare radiological finding in an infant with respiratory distress. Sudan J Paed. 2018; 18(2): 61-63. doi:10.24911/SJP.106-1521149016


Web Style

Gogou M, Giannopoulos A, Haidopoulou K. A rare radiological finding in an infant with respiratory distress. http://www.sudanjp.com/?mno=293899 [Access: February 18, 2019]. doi:10.24911/SJP.106-1521149016


AMA (American Medical Association) Style

Gogou M, Giannopoulos A, Haidopoulou K. A rare radiological finding in an infant with respiratory distress. Sudan J Paed. 2018; 18(2): 61-63. doi:10.24911/SJP.106-1521149016



Vancouver/ICMJE Style

Gogou M, Giannopoulos A, Haidopoulou K. A rare radiological finding in an infant with respiratory distress. Sudan J Paed. (2018), [cited February 18, 2019]; 18(2): 61-63. doi:10.24911/SJP.106-1521149016



Harvard Style

Gogou, M., Giannopoulos, . A. & Haidopoulou, . K. (2018) A rare radiological finding in an infant with respiratory distress. Sudan J Paed, 18 (2), 61-63. doi:10.24911/SJP.106-1521149016



Turabian Style

Gogou, Maria, Andreas Giannopoulos, and Katerina Haidopoulou. 2018. A rare radiological finding in an infant with respiratory distress. Sudanese Journal of Paediatrics, 18 (2), 61-63. doi:10.24911/SJP.106-1521149016



Chicago Style

Gogou, Maria, Andreas Giannopoulos, and Katerina Haidopoulou. "A rare radiological finding in an infant with respiratory distress." Sudanese Journal of Paediatrics 18 (2018), 61-63. doi:10.24911/SJP.106-1521149016



MLA (The Modern Language Association) Style

Gogou, Maria, Andreas Giannopoulos, and Katerina Haidopoulou. "A rare radiological finding in an infant with respiratory distress." Sudanese Journal of Paediatrics 18.2 (2018), 61-63. Print. doi:10.24911/SJP.106-1521149016



APA (American Psychological Association) Style

Gogou, M., Giannopoulos, . A. & Haidopoulou, . K. (2018) A rare radiological finding in an infant with respiratory distress. Sudanese Journal of Paediatrics, 18 (2), 61-63. doi:10.24911/SJP.106-1521149016





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