70 year old lady presents with collapse at home. On arrival GCS 5, O2 sats 70% on 15 liters and shifting minimal air on auscultation. Respiratory arrest whilst in upright position – breathing returned on lying supine.
NIDDM with degenerative OA of knees on metformin and meloxicam
Describe and interpret this CXR
CHEST X-RAY INTERPRETATION
Small lung volumes and atelectasis in the right base.
There is air under the right hemidiapragm and the liver appears displaced downwards.
This lady had a perforated bowel with free air in the abdomen – causing a ‘floating liver‘.
This supine film does not give the more obvious air under the diaphragm picture [See CXR Case 141]
She had severe metabolic acidosis and inflammatory response and survived surgery.
This is not Chilaiditi sign – but does have a similar appearance – where colonic interposition above the superior border of the liver – a cause of pseudo-pneumoperitoneum.
Chilaiditi syndrome (Demetrius Chilaiditi 1883–1975) – is interposition of the colon over the liver associated with upper abdominal pain.