Chilaiditi Sign: Involvement of the Large and Small Intestines?

We read with interest the case of Chilaiditi syndrome mimicking acute cholecystitis.1 The authors reported a rare instance whereby the small bowel interposed between the liver and right hemidiaphragm.1 We revisited Chilaiditi's paper, which detailed 3 cases involving partial, temporary liver displacement with interposed intestines.2 According to Chilaiditi, the transverse colon or right hepatic flexure commonly causes the displacement, with the extent and type depending on the distension of the interposed bowel and laxity of the hepatic ligaments.2 Chilaiditi acknowledged the challenges of diagnosing this condition during physical examination.2 Percussion findings indicated tympany, consistent with the radiographic findings, while palpation is more difficult, especially when the bowel loops are located anteriorly to the edge of displaced liver. Therefore, radiography is the preferred method for diagnosis and monitoring. Chilaiditi disputed involvement of the small bowel, arguing that the interposition of the small intestine alone could not anatomically cause such significant displacement of the liver.2 From fluoroscopic imaging and radiographs, he concluded that the large intestine was the part in question, a finding further confirmed by air-filled intestines observed per rectum.2 Chilaiditi acknowledged that some loops of the small intestine may occasionally move over the liver with the large intestine. However, he could not confirm the involvement of the small bowel in these cases. Some may argue that questioning the inclusion of small bowel interposition under the term Chilaiditi sign is merely a matter of semantics. However, we believe that medical eponyms should be accurately attributed based on the author's original description.3