Gradual Diaphragmatic Elevation and Chilaiditi Sign Associated With Phrenic Neuropathy Secondary to Cervical Disc Prolapse

We report the case of a 78-year-old male who presented to the emergency department with worsening dyspnoea, cough, and wheezing. Chest imaging revealed the Chilaiditi sign with the presence of a progressively elevated right hemidiaphragm. Chest X-rays taken in 2013, 2017, and 2025 showed a progressive rise in the right hemidiaphragm. Magnetic resonance imaging (MRI) of the cervical spine performed in 2025 revealed cervical spinal cord and/or nerve root compression (C3-C5). These MRI findings, together with the progressive nature of the raised right hemidiaphragm over many years, suggest that the Chilaiditi sign may have been associated with this cervical cord/root compression. The Chilaiditi sign describes the interposition of the colon between the liver and the diaphragm in the right subphrenic space, possibly resulting from various pathologies such as elevation of the right diaphragm, relaxation or damage to the cruciform ligament of the liver, or increased laxity/mobility of the colon. This case highlights a novel, previously unreported possibility that there might be an association of the Chilaiditi sign with cervical disc prolapse of C3-C5. Further studies are necessary to support this possible association.