Chilaiditi's Syndrome— Fact or Fancy?

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Abstract
TO THOSE accustomed to surveying routine chest roentgenograms, the appearance of interposed bowel gas between the right hemidiaphragm and the shadow of the liver is not a particularly unusual or disturbing observation. Physicians less experienced, however, might confuse this type of gas collection with serious pathological processes such as free intraperitoneal air or gas within an abscess. Since hepatodiaphragmatic interposition is said to occur in 0.025% of mass chest roentgenogram surveys,1complete familiarity with this entity is worthwhile. The roentgenographic observation of interposed bowel loops between the liver and diaphragm with the patient upright (Fig 1 and 2), together with the clinical features of abdominal pain, distention, and nocturnal vomiting, combined with physical findings of absent liver dullness or liver mass in the midabdomen or right lower quadrant,2has become known as Chilaiditi's syndrome. Although originally described as early as 1899 by Beclere,2,3and more substantially in

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