Chilaiditi syndrome mimicking congestive heart failure

Description

An 85-year-old man presented with orthopnoea and dyspnoea, symptoms of which were suspicious for heart failure. He was in respiratory distress and oxygen saturation was 85% on 4 L oxygen. On initial assessment, lungs were clear and heart sounds were normal. What was immediately evident was a distended abdomen. Digital rectal examination revealed hard faeces in rectum. He had a history of chronic constipation and last bowel movement was over 5 days ago.

Chest X-ray (figure 1) showed raised diaphragms with loops of large bowel interposed between the right hemidiaphragm and liver. An abdominal X-ray (figure 2) confirmed faecal impaction. Brain natriuretic peptide, d-dimer and echocardiogram were normal. He eventually underwent manual evacuation following failure of oral laxatives and enemas (figure 3 for follow-up chest X-ray).

Figure 1

Chest X-ray on presentation showing Chilaiditi sign and lungs compressed.

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