Chest X-ray Abnormalities
Costophrenic angle blunting

Key points

  • Pleural effusions are not the only cause of blunt costophrenic angles

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.

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