Madam, Chilaiditi's Syndrome is an infrequent condition with radiological evidence of symptomatic colonic interposition between the liver and diaphragm.¹ The diagnosis of this syndrome by erect abdominal and chest plain films is important, and it allows the differentiation from pneumoperitoneum, ruptured abdominal viscera, and subphrenic abscess to be made.² In general, patients are asymptomatic, but some patients have been associated with gastrointestinal and respiratory symptoms. The management is usually conservative and surgical intervention is rarely indicated.
A 65-year-old women was admitted to the hospital with a history of cough, abdominal pain, and recurrent respiratory distress. She was afebrile and haemodynamically stable. Tympany and high-pitched bowel sounds were audible over the right abdomen, which was diffusely tender without rebound tenderness. There was no surgical history. The chest X-ray revealed an elevation of the right hemi diaphragm (Figure), dilated colonic loop under the right hemi diaphragm (Figure).

1.Teng CS, Lin WJ, Tseng MH, Wang CC. Chilaiditi's syndrome in a 9-year-old girl with hepato-diaghragmatic inter-position of the colon: a short report. Eur J Pediatr 2005; 164: 119-20.
2.Schubert SR. Chilaiditi's syndrome: an unusual cause of chest or abdominal pain. Geriatrics 1998; 53: 85-8.