Department of Radiology, Marmara University Pendik Training and Research Hospital, Fevzi Çakmak, MuhsinYazıcıoğlu Cd No:10 Pendik, 34899, Istanbul, Turkey.
Department of Radiology, Faculty of Medicine, Marmara University, Istanbul, Turkey.
Surg Radiol Anat. 2022 Sep;44(9):1239-1246. doi: 10.1007/s00276-022-03013-7. Epub 2022 Sep 2.
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.
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 cm using Volume Viewer application in 75 cases (20 females, 55 males) in which Chilaiditi's sign was observed in CT images.
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).
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.
奇拉蒂蒂氏征是结肠位于肝膈之间的一种罕见征象，可能导致肝移植应用中出现问题，而此类应用的数量正在逐渐增加。尽管文献中没有报道，但我们在奇拉蒂蒂氏征患者的 CT 图像中观察到，肠间位区发生了肝萎缩。本研究旨在确定被插入结肠引起的肝萎缩量、导致萎缩率变化的因素，以及这种情况对肝实质的影响。
回顾性分析了 2012 年 3 月至 2013 年 3 月期间因任何原因就诊放射科并接受胸腹部或腹部 CT 成像的 30000 例患者。在 75 例 CT 图像中观察到奇拉蒂蒂氏征的患者中，使用 Volume Viewer 应用程序估计肝右叶和左叶外侧/内侧段的体积（cm）。
17-27%受结肠插入影响的肝叶出现萎缩。左叶萎缩（74%）患者的右叶体积与总肝体积之比高于右叶萎缩（55%）（p<0.001）。同样，右叶萎缩（45%）患者的左叶体积与总肝体积之比高于左叶萎缩（26%）（p<0.001）。
结肠肝膈间插入可引起肝萎缩。这种情况在肝移植应用中应特别考虑。未受影响的肝叶可能会发生代偿性肥大，CT 对诊断成像非常有用。
