A rare case of asthmatic patient with left Chilaiditi’s syndrome

The purpose of this clinical case is to underline the rarity of the case in question, in which the diagnosis of left Chilaiditis syndrome was made in a woman with bronchial asthma. The Caucasian woman in question is 79 years old and was seen in our clinic in January 2023 for episodes of recurrent dyspnea, chest heaviness, wheezing, belching, dysphagia and epigastric abdominal pain associated with recurrent episodes of bronchitis. We used simple spirometry, which revealed a picture of moderate mixed ventilatory deficit with a decrease in small airway volume, a reduction in peak expiratory flow, and a negative bronchoreversibility test. At 3 months, the patient recurred with a chest X-ray showing marked elevation of the left hemidiaphragm, with rightward deviation of the cardiac shadow. We repeated spirometry, which showed marked improvement compared to the previous control, with a significant change in peak expiratory flow during inhalation of corticosteroids/long-acting and β2-agonists, indicating the presence of an underlying condition of bronchial asthma. The radiological picture was identified as left Chilaiditis syndrome as the patient presented gastrointestinal symptoms in addition to the respiratory symptoms associated with radiological evidence of the ascent of the viscera in the chest on the left. Therapy with proton pump inhibitors was established with new-generation alginates with the presence of hyaluronic acid and also melatonin with important effects on the gastroesophageal system reflux disease secondary to this herniation of the viscera in the thoracic cavity. The rarity is represented by the left localization of the diaphragmatic hernia pathology.