Chilaiditi's Syndrome with Associated Angina

Symptomatic hepato-diaphragmatic interposition of a bowel loop or Chilaiditi's syndrome [Pronounced "Ky- La-Ditty"] is a very rare (0.1-0.25%) anatomical condition most often found by chance. Its described symptoms range from intermittent, mild abdominal pain and dyspepsia to acute intestinal obstruction. We report a case of acquired hepato-diaphragmatic migration of the hepatic flexure of the colon associated to an unusual, angina-like pain more in the left lateral position. ECG, stress test, 2D echo and regional cardiac injury markers were within normal limits indicating that the pain was unlikely due to myocardial ischemia. It is possible that the pain felt by the patient, concomitant to the migration of the hepatic flexure, was simply due to the transient stimulation of cardiac nervous fibers or to the internal compression of the chest or to overstretching of the major vessels-including the aorta and vena cava, or to a combination of these last two factors. This case suggests that Chilaiditi's syndrome should be included among the possible, although rare, causes of unexplained angina-like symptoms.