What is the Best Treatment for Costophrenic Angle Blunting?

What is Costophrenic Angle Blunting?

Costophrenic angle blunting is a radiological sign seen on a chest X-ray when the sharp angle between the diaphragm and the chest wall becomes rounded. Usually, doctors associate this with pleural effusion, also known as water on the lungs.

A 2021 study estimated that pleural effusion affects 320 people per 100,000 in India. Although the blunting may not cause any symptoms, it affects the appearance of the lungs.

Treatment for Costophrenic Angle Blunting

Costophrenic Angle Blunting is the first radiological sign of pleural effusion, especially when the effusion is mild. Treating the underlying cause of the pleural effusion will resolve the fluid buildup. As the effusion drains, the costophrenic angle will typically return to its normal sharp appearance on subsequent X-rays. Here are the different types of treatment options:

1. Medications

Healthcare providers suggest the following medications to treat the underlying symptoms:

• Diuretics and other heart failure-related medications to reduce fluid overload.
• Doctors prescribe antibiotic drugs to patients suffering from an infection.
• Doctors use oncological interventions like chemotherapy, radiotherapy, or palliative drainage to treat malignancy.

2. Thoracentesis

If the pleural effusion is significant, doctors suggest thoracentesis (chest tube drainage). It involves inserting a needle into the pleural space to drain the fluid, providing quick relief from breathlessness caused by fluid buildup. In most cases, a significant volume of fluid (often 500 - 1000 ml) can usually be drained safely for symptomatic relief.

3. Surgery

Some patients may require surgery in case of severe complications. Here are two types of surgeries available for Pleural effusion:

• Video-Assisted Thoracoscopic Surgery (VATS) : It is a minimally invasive surgical technique to treat pleural effusions that are difficult to drain or return due to a tumour. It involves inserting camera and surgical instruments through small incisions. It allows the surgeon to visualise the chest cavity on a monitor and perform the necessary procedures.
• Thoracotomy : It is also known as open thoracic surgery. This procedure involves cutting open the chest wall (6 inches to 8 inches) to access the organs within the thoracic cavity. Surgeons typically reserve thoracotomy for cases where other methods fail or when they need surgical intervention to treat the underlying cause of the effusion.

Diagnosis of Costophrenic Angle Blunting

Healthcare providers use these procedures to diagnose Costophrenic angle blunting:

1. Chest X-Ray : Costophrenic angle blunting is visible on X-ray when fluid exceeds 200 ml. In addition, lateral decubitus X-rays can detect even smaller amounts, such as 5 ml to 15 ml. Blunting may appear unilateral or bilateral, depending on the cause.
2. Ultrasound and CT Scan : Ultrasound is essential for locating effusions, while a CT scan helps detect small or complex effusions, pleural thickening, or tumours.

When is Treatment Required for Costophrenic Angle Blunting?

If someone experiences any unexplained breathlessness or chest heaviness, or if a chest X-ray shows costophrenic angle blunting, it is important to seek medical advice. Early treatment can prevent the condition from worsening or leading to further complications.

Costophrenic angle blunting is a subtle but significant radiological sign that often signals pleural effusion. The best treatment depends on identifying and managing the root cause of the costophrenic angle blunting sign. In most cases, it is managed successfully with modern imaging and effective treatments such as thoracentesis or VATS. Early intervention helps patients recover more quickly and decreases the risk of long-term complications.