A young lady presented with recurrent abdominal distention and pain. Over the past few years, she had been admitted several times with similar complaints. Each time the symptoms settled with conservative management. Abdominal radiography (Panel) on admission is shown above. What does the radiograph show and what is the syndrome ? Answer: refer to page 187 Images of Interest Brunei Int Med J. 2011; 7 (3): 165 Correspondence

(Refer to page 165) Answer: Chilaiditi’s sign and Chilaiditi’s syndrome Chilaiditi’s sign is defined by the asymptomatic interposition of part of the intestine (commonly the hepatic flexure of the colon) between the right hemi-diaphragm and the liver. It is usually an incidental finding. When symptomatic, it is referred to as the Chilaiditi’s syndrome. Presentations may range from intermittent recurrent mild abdominal pain to acute intestinal volvulus, though the symptoms reported so far have been inconsistent between different patients and can be nonspecific.

A young lady was evaluated for chronic iron deficiency anaemia and a long history of intermittent dysphagia especially to solids. The dysphagia had been more prominent in the previous few months. There was no history of menorrhagia. Apart from pallor and mild koilonychias, physical examination was unremarkable. She underwent a barium swallow (panel) and an abnormality was detected. What is the diagnosis? Answer: refer to page 236

(Refer to page 208) Answer: Plummer-Vinson or Patterson-Kelly-Brown Syndrome Plummer-Vinson syndrome (PVS) is defined as a triad of upper oesophageal web (or ring), dysphagia and iron deficiency anaemia (IDA). It was first reported in the early twentieth century, and is also widely known as the Patterson- Kelly-Brown syndrome (PKBS) or sideropenic anaemia with epithelial lesions.