Chilaiditi’s Sign (CS) is a radiological finding on an abdominal radiograph due to colonic interposition between the liver and the diaphragm giving a false impression of free intra peritoneal air. When accompanied by abdominal symptoms, a syndrome with the same name is diagnosed. As elusive a finding, it can be a source of diagnostic misinterpretation causing an alarming illusion of a deceptive emergency.
We report a four-year-old girl presenting with an acute abdomen in a background of long-standing constipation and an illusory radiograph suggesting left-sided, free sub diaphragmatic air. Further imaging with a CECT confirmed mesenteric lymphadenitis without free peritoneal air and chronic constipation as a cause of symptoms. Expectant management resulted in gradual clinical improvement.
Chilaiditi’s syndrome or CS is more often described in adults and more frequently over the right side, nevertheless, can occur in children too. Knowledge of its occurrence can avoid unnecessary surgical intervention.
While evaluating a child with acute abdomen, if the finding of a radiographic free sub diaphragmatic air is discordant with clinical signs, further imaging to rule out CS is important to avoid unnecessary exploration.

Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.