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The volumetric measurement of developing liver atrophy in patients with Chilaiditi's sign

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Abstract

Purpose

The Chilaiditi's sign is a hepatodiaphragmatic interposition of the colon and is a rare diagnosed condition. This condition may cause a problem in liver transplantation applications which are progressively increasing in number. Although not reported in the literature, we observed that liver atrophy developed in the intestinal interposition region in patients with Chilaiditi's sign in computed tomography (CT) images. This study aimed to determine the amount of liver atrophy caused by the interposed colon, the factors that change the rate of atrophy, and the effects of this situation on the liver parenchyma.

Materials and methods

A total of 30,000 patients who presented to radiology department with any reason between March 2012 and March 2013 and who underwent thoracoabdominal or abdominal CT imaging were retrospectively analyzed. The volumes of the liver right lobe and lateral/medial segments of the left lobe were estimated in cm3 using Volume Viewer application in 75 cases (20 females, 55 males) in which Chilaiditi's sign was observed in CT images.

Results

17–27% of the lobes affected from the colon interposition were seen to develop atrophy. The ratio of right lobe volume to total liver volume was found to be higher in patients with left lobe atrophy (74%) than right lobe atrophy (55%) (p < 0.001). Similarly, the rate of the volume of the left lobe to the total liver volume was found to be higher in cases with right lobe atrophy (45%) compared to left lobe atrophy (26%) (p < 0.001).

Conclusion

Hepatodiaphragmatic interposition of the colon can cause liver atrophy. This condition should especially be considered in the liver transplantation applications. Compensatory hypertrophy may develop in the unaffected liver lobe and CT is very useful for diagnostic imaging.

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All data generated or analyzed during this study are included in this published article.

References

  1. Alva S, Shetty-Alva N, Longo WE (2008) Image of the month. Chilaiditi sign or syndrome Arch Surg 143:93–94. https://doi.org/10.1001/archsurg.2007.12-a

    Article  PubMed  Google Scholar 

  2. Barroso Jornet JM, Balaguer A, Escribano J, Pagone F, Domenech J, del Castillo D (2003) Chilaiditi syndrome associated with transverse colon volvulus: first report in a paediatric patient and review of the literature. Eur J Pediatr Surg 13:425–428. https://doi.org/10.1055/s-2003-44737

    Article  CAS  PubMed  Google Scholar 

  3. Bilodeau M, Aubry MC, Houle R, Burnes PN, Ethier C (1999) Evaluation of hepatocyte injury following partial ligation of the left portal vein. J Hepatol 30:29–37. https://doi.org/10.1016/s0168-8278(99)80005-1

    Article  CAS  PubMed  Google Scholar 

  4. Caicedo L, Wasuwanich P, Rivera A, Lopez MS, Karnsakul W (2021) Chilaiditi syndrome in pediatric patients—symptomatic hepatodiaphragmatic interposition of colon: a case report and review of literature. World J Clin Pediatr 10:40–47. https://doi.org/10.5409/wjcp.v10.i3.40

    Article  PubMed  PubMed Central  Google Scholar 

  5. Chinnappan K, Abhyankar A, Jameel Z (2008) Chilaiditi’s syndrome with cecal volvulus and perforation. Am Surg 74:1220–1222

    Article  Google Scholar 

  6. Elnaggar AS, Griesemer AD, Bentley-Hibbert S, Brown RS Jr, Martinez M, Lobritto SJ et al (2018) Liver atrophy and regeneration in noncirrhotic portal vein thrombosis: Effect of surgical shunts. Liver Transpl 24:881–887. https://doi.org/10.1002/lt.25024

    Article  PubMed  Google Scholar 

  7. Farkas R, Moalem J, Hammond J (2008) Chilaiditi’s sign in a blunt trauma patient: a case report and review of the literature. J Trauma 65:1540–1542. https://doi.org/10.1097/01.ta.0000208194.49228.03

    Article  PubMed  Google Scholar 

  8. Fisher AA, Davis MW (2003) An elderly man with chest pain, shortness of breath, and constipation. Postgrad Med J 79:180–184. https://doi.org/10.1136/pmj.79.929.180

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Fiumecaldo D, Buck L (2018) Chilaiditi’s syndrome causing high-grade small-bowel obstruction requiring exploratory laparotomy. Mil Med 183:e281–e283. https://doi.org/10.1093/milmed/usx069

    Article  PubMed  Google Scholar 

  10. Flores N, Ingar C, Sánchez J, Fernández J, Lazarte C, Málaga J et al (2005) The Chilaiditi syndrome and associated volvulus of the transverse colon. Rev Gastroenterol Peru 25:279–284

    PubMed  Google Scholar 

  11. Friesen BR, Gibson RN, Speer T, Vincent JM, Stella D, Collier NA (2011) Lobar and segmental liver atrophy associated with hilar cholangiocarcinoma and the impact of hilar biliary anatomical variants: a pictorial essay. Insights Imaging 2:525–531. https://doi.org/10.1007/s13244-011-0100-9

    Article  PubMed  PubMed Central  Google Scholar 

  12. Glatter RD, April RS, Miskovitz P, Neistadt LD (2007) Severe recurrent abdominal pain: an anatomical variant of Chilaiditi’s syndrome. MedGenMed 9:67

    PubMed  PubMed Central  Google Scholar 

  13. Hecht EM, Wang ZJ, Kambadakone A, Griesemer AD, Fowler KJ, Heimbach JK et al (2019) Living donor liver transplantation: preoperative planning and postoperative complications. AJR Am J Roentgenol 213:65–76. https://doi.org/10.2214/AJR.18.21064

    Article  PubMed  Google Scholar 

  14. Indiran V, Kannan K, Ramachandra Prasad T, Maduraimuthu P (2017) Chilaiditi sign. Abdom Radiol (NY) 42:2188–2189. https://doi.org/10.1007/s00261-017-1104-9

    Article  Google Scholar 

  15. Ji F, Zhang S, Jiang A, Deng H, Li Z (2014) Hypogenesis of the right hepatic lobe and associated Chilaiditi sign. ANZ J Surg 84:394. https://doi.org/10.1111/ans.12568

    Article  PubMed  Google Scholar 

  16. Kaushik S, Fulcher AS, Turner MA (2003) Segmental hepatic atrophy: a sequela of blunt intrahepatic bile duct injury. J Trauma 54:1225–1227. https://doi.org/10.1097/01.TA.0000028047.45160.F9

    Article  PubMed  Google Scholar 

  17. Kim RD, Kim JS, Watanabe G, Mohuczy D, Behrns KE (2008) Liver regeneration and the atrophy-hypertrophy complex. Semin Intervent Radiol 25:92–103. https://doi.org/10.1055/s-2008-1076679

    Article  PubMed  PubMed Central  Google Scholar 

  18. Lorigan JG, Charnsangavej C, Carrasco CH, Richli WR, Wallace S (1988) Atrophy with compensatory hypertrophy of the liver in hepatic neoplasms: radiographic findings. AJR Am J Roentgenol 150:1291–1295. https://doi.org/10.2214/ajr.150.6.1291

    Article  CAS  PubMed  Google Scholar 

  19. Majumder S (2013) Education and imaging. Gastrointestinal: hepatodiaphragmatic interposition of small bowel loop: a rare cause of Chilaiditi's syndrome. J Gastroenterol Hepatol. 28:1253. https://doi.org/10.1111/jgh.12299

  20. Nakagawa H, Toda N, Taniguchi M, Ibukuro K, Tagawa K (2006) Prevalence and sonographic detection of Chilaiditi’s sign in cirrhotic patients without ascites. AJR Am J Roentgenol 187:W589–W593. https://doi.org/10.2214/AJR.05.0597

    Article  PubMed  Google Scholar 

  21. Orangio GR, Fazio VW, Winkelman E, McGonagle BA (1986) The Chilaiditi syndrome and associated volvulus of the transverse colon. An indication for surgical therapy. Dis Colon Rectum 29:653–656. https://doi.org/10.1007/BF02560330

    Article  CAS  PubMed  Google Scholar 

  22. Plorde JJ, Raker EJ (1996) Transverse colon volvulus and associated Chilaiditi’s syndrome: case report and literature review. Am J Gastroenterol 91:2613–2616

    CAS  PubMed  Google Scholar 

  23. Radin DR, Colletti PM, Ralls PW, Boswell WD Jr, Halls JM (1987) Agenesis of the right lobe of the liver. Radiology 164:639–642. https://doi.org/10.1148/radiology.164.3.3303118

    Article  CAS  PubMed  Google Scholar 

  24. Saber AA, Boros MJ (2005) Chilaiditi’s syndrome: what should every surgeon know? Am Surg 71:261–263. https://doi.org/10.1177/000313480507100318

    Article  PubMed  Google Scholar 

  25. Schweizer W, Duda P, Tanner S, Balsiger D, Höflin F, Blumgart LH et al (1995) Experimental atrophy/hypertrophy complex (AHC) of the liver: portal vein, but not bile duct obstruction, is the main driving force for the development of AHC in the rat. J Hepatol 23:71–78. https://doi.org/10.1016/0168-8278(95)80313-0

    Article  CAS  PubMed  Google Scholar 

  26. Vernuccio F, Whitney SA, Ravindra K, Marin D (2021) CT and MR imaging evaluation of living liver donors. Abdom Radiol (NY). 46:17–28. https://doi.org/10.1007/s00261-019-02385-6

  27. Vilgrain V, Condat B, Bureau C, Hakimé A, Plessier A, Cazals-Hatem D et al (2006) Atrophy-hypertrophy complex in patients with cavernous transformation of the portal vein: CT evaluation. Radiology 241:149–155. https://doi.org/10.1148/radiol.2411051102

    Article  PubMed  Google Scholar 

  28. Weng WH, Liu DR, Feng CC, Que RS (2014) Colonic interposition between the liver and left diaphragm—management of Chilaiditi syndrome: a case report and literature review. Oncol Lett 7:1657–1660. https://doi.org/10.3892/ol.2014.1903

    Article  PubMed  PubMed Central  Google Scholar 

  29. Yavuz A, Batur A, Bulut MD, Bora A, Göya C, Andic C et al (2015) Anterior hepatic grooves accompanied by Chilaiditi sign: a retrospective radiological analysis of a neglected anatomical fact. Surg Radiol Anat 37:483–492. https://doi.org/10.1007/s00276-015-1443-6

    Article  PubMed  Google Scholar 

  30. Yin AX, Park GH, Garnett GM, Balfour JF (2012) Chilaiditi syndrome precipitated by colonoscopy: a case report and review of the literature. Hawaii J Med Public Health 71:158–162

    PubMed  PubMed Central  Google Scholar 

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Acknowledgements

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Funding

No funding was received from any source for this study.

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Authors and Affiliations

  1. Department of Radiology, Marmara University Pendik Training and Research Hospital, Fevzi Çakmak, MuhsinYazıcıoğlu Cd No:10 Pendik, 34899, Istanbul, Turkey

    Hatice Kaya & Emrah Karatay

  2. Department of Radiology, Faculty of Medicine, Marmara University, Istanbul, Turkey

    Davut Tuney

Authors
  1. Hatice Kaya
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  2. Emrah Karatay
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Contributions

HK: protocol and project development, data collection and management, data analysis, manuscript writing and editing. EK: protocol and project development, data collection and management, data analysis, manuscript writing and editing. DT: protocol and project development, data analysis, manuscript writing and editing.

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Correspondence to Emrah Karatay.

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The authors of this paper have no conflict of interest to declare.

Ethics approval

This retrospective study was approved by Marmara University Clinical Research Ethics Committee (IRB: 13/297, 09.2013.0247). This study has been carried out in accordance with the standards set out in the Code of Ethics of the World Medical Association (Declaration of Helsinki).

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Kaya, H., Karatay, E. & Tuney, D. The volumetric measurement of developing liver atrophy in patients with Chilaiditi's sign. Surg Radiol Anat 44, 1239–1246 (2022). https://doi.org/10.1007/s00276-022-03013-7

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  • DOI: https://doi.org/10.1007/s00276-022-03013-7

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