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A Rare Etiology of Right-sided Pseudopneumoperitoneum

Chilaiditi sign is a rare, usually benign intestinal radiographic phenomenon, produced by the interposition of the colon or small bowel in the hepatodiaphragmatic space. Clinically, it can appear as an asymptomatic anatomic abnormality or with an array of gastrointestinal symptoms, most commonly abdominal pain. Diagnosis is usually an incidental finding noted on routine chest x-ray. Identification of Chilaiditi sign is important to recognize to limit unnecessary radiologic and surgical interventions. We present the case of a 71-year-old man with an incidental chest x-ray finding of gaseous distention below the right hemidiaphragm. He was asymptomatic and managed conservatively.