Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts 1167


 
 Table of Contents  
LETTER TO EDITOR
Year : 2018  |  Volume : 9  |  Issue : 1  |  Page : 39-40

Costophrenic angle blunting: Always abnormal?


Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India

Date of Web Publication24-Jan-2018

Correspondence Address:
Dr. Venkatraman Indiran
Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, 7 Works Road, Chromepet, Chennai - 600 044, Tamil Nadu
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjmsr.mjmsr_35_17

Rights and Permissions
How to cite this article:
Indiran V. Costophrenic angle blunting: Always abnormal?. Muller J Med Sci Res 2018;9:39-40

How to cite this URL:
Indiran V. Costophrenic angle blunting: Always abnormal?. Muller J Med Sci Res [serial online] 2018 [cited 2019 Nov 16];9:39-40. Available from: http://www.mjmsr.net/text.asp?2018/9/1/39/223909

Dear Editor,

Costophrenic (CP) angle or the costodiaphragmatic recess is one of the review areas in reading a chest radiograph systematically. Normally, the CP angle is acute and sharp. Normal CP angle measures approximately 30°. Alteration in shape and angle may occur as part of blunting and usually indicates pleural or pulmonary disease. Isolated blunting of the CP angle is usually considered to represent pleural disease such as small pleural effusion or mild pleural thickening. Chronic obstructive pulmonary disease with hyperinflation may also alter the CP angle due to diaphragmatic flattening. Deep CP angles may occur in tension pneumothorax.

Classically, isolated blunting of the CP angle on chest radiograph (posteroanterior view) has been taught to represent about 200 ml of the pleural fluid.[1] Suspicion of the pleural fluid may be ascertained using lateral decubitus radiograph or ultrasound examination.

However, there are some instances where we encounter such mild blunting of the CP angles in an otherwise normal chest radiograph, in people presenting for preventive health checkups, preemployment, or preimmigration screening [Figure 1]. We had always raised the possibility of small pleural effusion or mild pleural thickening, based on the classical teaching. However, a recent study by Matsumoto-Yamazaki et al. tried to assess the radiographic measurements, spirometry, and clinical symptoms in such subjects with a stable blunt CP angle during company medical check.[2] Subjects with stable blunt CP angles were those who had blunted CP angle at least 3 consecutive years without any progression. Although exact pathophysiological basis of blunt CP angle could not be identified, possible explanation was the inhomogeneity of regional ventilation due with flow-to-volume dysanapsis.
Figure 1: Normal chest radiograph except for mildly blunted costophrenic angles

Click here to view


The essential learning point would be that stable blunt CP angles may be seen without significant pulmonary and pleural disease, and it would be prudent not to undertake extensive investigations for blunt CP angles seen, especially those seen in the asymptomatic patients undergoing preventive or screening checkups. Screening ultrasound of the CP angles alone may suffice in such situations. Larger studies of stable blunt CP angle seen in master health checkups in Indian setting can throw more light on this particular scenario.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Na MJ. Diagnostic tools of pleural effusion. Tuberc Respir Dis (Seoul) 2014;76:199-210.  Back to cited text no. 1
[PUBMED]    
2.
Matsumoto-Yamazaki M, Ohwada A, Shiota S, Takahashi K. A stable blunt costophrenic angle in healthy subjects, associated with dysanapsis and airflow limitation. J Pulm Respir Med 2014;4:210. doi:10.4172/2161-105X.1000210.  Back to cited text no. 2
    


    Figures

  [Figure 1]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
References
Article Figures

 Article Access Statistics
    Viewed29752    
    Printed88    
    Emailed0    
    PDF Downloaded269    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]