Song D, Seen T, Almas T, Ireifej B, Kupferman J, Khedro T, Alshamlan A, Abdulhadi A, Sattar Y, Alraies MC. Chilaiditi syndrome: A structural displacement in a heart failure patient.
Ann Med Surg (Lond) 2021;
68:102687. [PMID:
34401144 PMCID:
PMC8353377 DOI:
10.1016/j.amsu.2021.102687]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 12/02/2022] Open
Abstract
Background
Chilaiditi's sign is often found incidentally on chest or abdominal radiograph and can be accompanied by clinical symptoms such as abdominal pain, gastrointestinal complications, and less commonly associated with dyspnea.
Case presentation
In this interesting case, we discover lingering dyspnea in our 79 year old male with a past medical history of asthma and heart failure with preserved ejection fraction admitted for acute heart failure exacerbation with reduced ejection fraction along with a new incidental finding of Chilaiditi's sign on chest radiograph. Patient received optimal diuretics and guideline-directed medical treatment for heart failure exacerbation, but mild dyspnea with pleuritic chest pain persisted. Dyspnea with pleurisy was likely attributed to a structural anatomical defect (Chilaiditi's sign) that can be picked up on imaging.
Conclusion
Chilaiditi syndrome can be an incidental cause of ongoing persistent dyspnea, and if symptoms are severe, intervention can be warranted for symptomatic resolution.
Learning objective
Chilaiditi syndrome should be considered as a possible diagnosis among patients with a history of heart failure and incidental Chilaiditi's sign on chest radiographic imaging who suffer from persistent dyspnea and pleurisy despite optimal diuretics and guideline-directed medical treatment.
Chilaiditi's sign in an incidental finding on chest or abdominal radiograph associated with gastrointestinal symptoms and less commonly associated with dyspnea.
Chilaiditi's sign with underlying heart failure is not well understood.
Chilaiditi syndrome should be considered as a possible diagnosis among patients with a history of heart failure and incidental Chilaiditi's sign on chest radiographic imaging who suffer from persistent dyspnea and pleurisy despite optimal diuretics and guideline-directed medical treatment.
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