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Heart-touching Chilaiditi's syndrome

World Journal of Gastroenterology 2005年第29期11卷 4607-4609页

作者： Dario Sorrentino Massimo Bazzocchi luigi badano Francesco Toso Pietro Giagu GI Unit-Internal Medicine of the Department of Clinical and Experimental Pathology and Department of Radiology University of Udine School of Medicine and Division of Cardiology Udine General Hospital Udine Italy

Symptomatic hepato-diaphragmatic interposition of a bowel loop or Chilaiditi's syndrome is a peculiar anatomical condition most often found by chance. Its described symptoms range from intermittent, mild abdominal pain and dyspepsia to acute intestinal obstruction. We report a case of hepato-diaphragmatic migration of the hepatic flexure of the colon associated to an unusual, heretofore unreported, angina-like pain exclusively evoked by the left lateral decubitus. To maximize the chance of observing anatomical changes in different postures, computed tomography of the chest and abdomen was performed after air insufflation into the colon. While frank herniation into the chest was excluded, the scan showed that the hepatic flexure-with the interposition of the diaphragm-came in contact with the right side of the heart in the left lateral, but not in the supine, decubitus. This finding was reproduced by echocardiography which also showed virtually unaltered hemodynamics after the change of posture. ECG, left and right ventricular global and regional function as well as cardiac injury markers also remained unchanged during the maneuver, indicating that the pain evoked by the latter was unlikely due to myocardial ischemia. This case suggests that Chilaiditi's syndrome should be included among the possible, although rare,causes of unexplained angina-like symptoms.

关键词： Chilaiditi's syndrome Hepatodiaphragmatic interposition Precordial pain

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