Blunting of the costophrenic angles is usually caused by a pleural effusion, as already discussed. Other causes of costophrenic angle blunting include lung disease in the region of the costophrenic angle, and lung hyperexpansion.
Chest X-ray Abnormalities
Costophrenic angle blunting
Key points
- Pleural effusions are not the only cause of blunt costophrenic angles
Right costophrenic angle blunting
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Right costophrenic angle blunting
- The left costophrenic angle is sharply defined (normal)
- The right costophrenic angle is blunt (abnormal)
- There is volume loss in the right hemithorax with corresponding shift of the mediastinum and trachea to the right (arrows)
- Note: Pleural effusions do not cause volume loss
Clinical information
- Chronic smoker
- Chronic shortness of breath with recent worsening
Diagnosis
- Lung cancer occluding the central airways with collapse of the right middle and lower lobes – confirmed by CT and bronchoscopy
Lung hyperexpansion
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Lung hyperexpansion
- Both costophrenic angles are blunt due to lung hyper-expansion
- The hemidiaphragms are flattened indicating hyperexpansion
- The lung markings are distorted bilaterally
Clinical information
- Occasional and passive smoker
- Chronic liver disease
Diagnosis
- Chronic obstructive pulmonary disease
- Underlying alpha-1-antitrypsin deficiency