Normal costophrenic angle measures approximately 30 degrees. Position patients with altered consciousness in a semirecumbent position with the head of the bed at a 30-45 angle. Asked for Male, 51 Years. Most common cause is pleural effusion. Accessed Oct. 26, 2006. This involves the use of shock waves to break up the stone into smaller pieces that can pass out through your urine. Created for people with ongoing healthcare needs but benefits everyone. There can be many reasons for a pathological condition to develop in the lungs. The costodiaphragmatic recess, also called the costophrenic recess or phrenicocostal sinus, is the posterolateral fringe of the pleural space, a potential space around the lung inside the pleural cavity.It is located at the acutely angled junction ("reflection") between the costal and diaphragmatic parietal pleurae, and is interpreted two-dimensionally on plain X-rays as the costophrenic angle. . Empyema necessitatis is soft-tissue extension of empyema leading to chest wall infection and external drainage. Trapped lung is a lung encased by a fibrous peel caused by empyema or tumor. Your risk is related to the initial condition. Costophrenic (CP) angle or the costodiaphragmatic recess is one of the review areas in reading a chest radiograph systematically. Explore lung, breathing and allergy disorders, treatments, tests and prevention services provided by the Cleveland Clinic Respiratory Institute. Or, if its small, the doctor may remove it. How many Costophrenic angles are there? . This cookie is set by GDPR Cookie Consent plugin. DOI: Flores-Mireles AL, et al. . Chest X-ray (CXR) Interpretation 2 (1) - Read online for free. But larger kidney stones can be very painful as they move through your urinary tract. Treatment should be aimed at the underlying cause, with removal of offending agents if possible. The effusion itself generally does not require treatment if it is asymptomatic because many effusions resorb spontaneously when the underlying disorder is treated, especially effusions due to uncomplicated pneumonias, pulmonary embolism, or surgery. Functional cookies help to perform certain functionalities like sharing the content of the website on social media platforms, collect feedbacks, and other third-party features. Some patients with pleural effusion have no symptoms, with the condition discovered on a chest x-ray that is performed for another reason. Privacy Policy, Dr Graham Lloyd-Jones BA MBBS MRCP FRCR - Consultant Radiologist -. I get my chest x-ray which says "Right costophrenic angle is blunted" what does it mean? Blunting of the costophrenic angle (also known as blunting of the costophrenic sulcus) is a chest radiograph sign usually indicative of a small pleural effusion. . (2018). Its best to see a doctor when you have tenderness or pain in this area. Because of antibiotic resistance, more and more people are seeking alternative treatments for UTIs. Pleural fluid analysis is done to diagnose the cause of pleural effusion. The tests may include: You may have other tests, depending on your particular symptoms and what your doctor suspects as a cause. . 1 What causes blunting of Costophrenic angles? Chest. Pain in this flank area may indicate a kidney infection, a back problem, or another kind of internal problem. Blunting of the lateral costophrenic angle usually requires about 175 mL but may take as much as 500 mL. Effusions with no obvious cause are often due to occult pulmonary emboli Pulmonary Embolism (PE) Pulmonary embolism (PE) is the occlusion of pulmonary arteries by thrombi that originate elsewhere, typically in the large veins of the legs or pelvis. But in few cases they are incidence of bilateral pleural effusion presence noticed. The isolated blunting of the costophrenic angle represent pleural . Blunting of a costophrenic angle is the classic sign for pleural effusion. Most all antibiotics penetrate the pleural cavity with a high enough concentration to be effective. can you please explain the above mentioned x-ray result. . Radiology Masterclass, Department of Radiology, Normally, the CP angle is acute and sharp. You can learn more about how we ensure our content is accurate and current by reading our. . Long B. Jokes apart, commonest cause of costophrenic angle blunting is accumulation of fluid in small amounts in the pleural cavity around the lung. Get To Know What Possibly Could Be Causing Your Symptoms! Then try and touch the fingertips together in front of chest. X- . Costovertebral pain syndromes. In order to confirm the diagnosis of Costophrenic Angle Blunting, the physician will order a chest x-ray. It may be seen on either frontal or lateral erect projections. How to tell and location, type of pain, and severity. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. A pleural friction rub, although infrequent, is the classic physical sign. Costophrenic blunting is often due to the presence of a pleural effusion, but it can also be related to other pleural disease or lung disease. Tuberculosis most commonly affects the lungs. Blunting of costophrenic angle is a x-ray finding. The seriousness of the condition depends on the primary cause of pleural effusion, whether breathing is affected, and whether it can be treated effectively. DOI: Scales CD, et al. "Pleural effusion." We also use third-party cookies that help us analyze and understand how you use this website. . A standard assessment your doctor may perform for CVA tenderness is placing one hand flat on the CVA area and thumping their flat hand with their other fist. Fluid should always be sent for total protein, lactate dehydrogenase (LDH), cell count and cell differential, Gram stain, and aerobic and anaerobic bacterial cultures. B: The lateral view shows increased depth and lucency of the retrosternal space. . Lung is one of the vital organs of our body. What causes blunting of the lung? Pleural effusions that cannot be managed through drainage or pleural sclerosis may require surgical treatment. Malignant pleural effusion. National Cancer Institute. . D Diaphragm 1-3 costophrenic angleC-P anglecardiophrenic angle C-P angle . Or you could get other medicines to treat heart failure. Costophrenic angle is observed on plain X-ray on right and left side. Transudative effusions are caused by some combination of increased hydrostatic pressure and decreased plasma oncotic pressure. b. Isolated costophrenic blunting without other signs of pleural effusion is estimated to represent approximately 300mL of pleural fluid. Acute pyelonephritis in pregnancy and the outcomes in pregnant patients. (2007). Pleural fluid accumulates when too much fluid enters or too little exits the pleural space. Computer Analysis of Digital chest X-Ray2. Pleurodesis procedure is performed to obliterate the pleural space. If the diagnosis remains unclear after pleural fluid analysis, CT angiography is indicated to look for pulmonary emboli, pulmonary infiltrates, or mediastinal lesions. . Whenever possible, thoracentesis is done using ultrasonographic guidance, which increases the yield of fluid and decreases risk of complications such as pneumothorax or puncture of an intra-abdominal organ. Costophrenic angle is the angle formed by the ribs at the sides, namely between the costal margin and the diaphragm. Costophrenic angle blunting and the presence of a meniscus are signs of a parapneumonic pleural effusion. DOI: Key statistics about kidney cancer. Read more to find out which products they sell and whether theyre effective. Blanchette MA, Grenier JM. 4 What does Costophrenic mean in medical terms? Learn how we can help 1.4k views Reviewed >2 years ago Thank CT is not routinely indicated but is valuable for evaluating the underlying lung parenchyma for infiltrates or masses when the lung is obscured by the effusion or when the detail on chest x-rays is insufficient for distinguishing loculated fluid from a solid mass. Chest xray interpretation easy Radiology Masterclass, Department of Radiology, Pleural effusions are not the only cause of blunt costophrenic angles, 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 (, Chronic shortness of breath with recent worsening, Lung cancer occluding the central airways with collapse of the right middle and lower lobes confirmed by CT and bronchoscopy, Both costophrenic angles are blunt due to lung hyper-expansion, The hemidiaphragms are flattened indicating hyperexpansion, The lung markings are distorted bilaterally, Underlying alpha-1-antitrypsin deficiency. Request a Free 2023 Mesothelioma Guide. When you have pain or tenderness in the CVA area, you should see your doctor. . Effusions first become apparent on lateral upright radiographs with blunting of the posterior costophrenic angle. A minor pleural effusion often goes away on its own without treatment. Diagnostic tests are indicated to document the presence of pleural fluid and to determine its cause (see figure Diagnosis of Pleural Effusion Diagnosis of pleural effusion ). Asbestos pleural effusion (due to exposure to asbestos) Meig's syndrome (due to a benign ovarian tumor) Ovarian hyperstimulation syndrome. Best Answer. This reduces the risk of aspiration leading to pneumonia. A minimally-invasive approach that is completed through 1 to 3 small (approximately -inch) incisions in the chest. Karakonstantis S, et al. Copyright 2023 Merck & Co., Inc., Rahway, NJ, USA and its affiliates. , , , . 1]. Medical Videos Privacy Policy, Images and Text Policy Editorial Policy, Information Policy Advertising Policy, Financial Disclosure Policy Cookie Policy, About Us Contact Us. Other symptoms include: Lower-tract UTIs affect the urethra and bladder. Answer (1 of 2): Since this is no diagnosis you need to see a doc to discuss this probably normal variant finding, slternately what further exams need to be done to exclude any real disease. Cleveland Clinic is a non-profit academic medical center. , X- . The lungs appear lucent, and vessel size is reduced. views, likes, loves, comments, shares, Facebook Watch Videos from Mike Natter Medical: "Where'd your costophrenic angles go, bruh?" #CHF aka congestive heart failure is a condition of. Detection of cause and treatment is the most appropriate treatment. Other tests (glucose, cytology, tuberculosis fluid markers [adenosine deaminase or interferon-gamma], amylase, mycobacterial and fungal stains and cultures) are used in appropriate clinical settings. Lung hyperexpansion can also lead to blunting of the costophrenic angles. In anatomy, the costophrenic angles are the places where the diaphragm (-phrenic) meets the ribs (costo-). What Could Be Causing Pain on the Left Side of Your Middle Back? Removal of pleura results in decreased secretions of serous fluid since pleura is removed. "Blunting of left c.p angle". This can be caused by various conditions such as infections, heart failure, lung cancer, autoimmune diseases, and trauma. . Source publication. It is seen in cases of pleural effusion. Causes, symptoms, treatment, preventive measures, and read more , cancer, pulmonary embolism Pulmonary Embolism (PE) Pulmonary embolism (PE) is the occlusion of pulmonary arteries by thrombi that originate elsewhere, typically in the large veins of the legs or pelvis. It has been found that approximately 200 mL pleural fluid needs to be present for blunting of a costophrenic angle to be visible on a lateral chest radiograph. Findings of pulmonary emboli indicate the need for long-term anticoagulation; parenchymal infiltrates, the need for bronchoscopy; and mediastinal lesions, the need for transthoracic needle aspiration or mediastinoscopy. The patient may have unrelated symptoms due to the disease or condition that has caused the effusion.Symptoms of pleural effusion include: Pleural effusions are very common, with approximately 100,000 cases diagnosed in the United States each year, according to the National Cancer Institute. Also known as thoracoscopic surgery, this procedure is effective in managing pleural effusions that are difficult to drain or recur due to malignancy. Each costophrenic angle can normally be seen as on chest x-ray as a sharply-pointed, downward indentation (dark) between each hemi-diaphragm (white) and the adjacent chest wall (white). 1. Lights criteria correctly identify almost all exudates but misidentify about 20% of transudates as exudates. It is important to note that minor blunting may be caused by scarring or chronic atelectasis. Your electronic clinical medicine handbook. Diaphragms and Pleural Effusion - How to Read a Chest X-Ray (Part 8) - MEDZCOOL 42 related questions found 6 Home Remedies for Urinary Tract Infections (UTIs), Your Guide to Emphysematous Cystitis (EC) and How to Treat It, increased frequency and urgency of urination, family history of kidney disease, heart attack, or stroke. Combined fluid complications. Last medically reviewed on September 27, 2018, Flank pain refers to discomfort in your upper abdomen or back and sides. Is treating a UTI without antibiotics possible? Thoracoscopy is a minimally invasive technique, also known as video-assisted thoracoscopic surgery, or VATS, performed under general anesthesia that allows for a visual evaluation of the pleura). , , . This article may contains scientific references. How can I remove fluid from my lungs at home? - . - . Eventually this can lead to kidney failure or end-stage renal disease. If you're a person prone to urinary tract infections (UTI), check out our top picks for the best at-home test kits. X-Ray of patient suffering with Pleural Effusion, Hemothorax and Pleural Abscess more often will show Costophrenic Angle Blunting. Despite common practice, chest x-ray need not be repeated after thoracentesis unless patients develop symptoms suggesting pneumothorax (dyspnea or chest pain) or unless the clinician suspects that air may have entered the pleural space during the procedure. It is important to note that minor blunting may be caused by scarring or chronic atelectasis. Effusions that are chronic, recurrent, and causing symptoms can be treated with pleurodesis or by intermittent drainage with an indwelling catheter. Antibiotics are selected according to bacterial sensitivity test. Pleural effusion is accumulation of fluid in the area between the chest wall and lungs. There are numerous causes (see table Causes of Pleural Effusion Causes of Pleural Effusion* ). What causes costophrenic angle blunting and how is it treated? A minor pleural effusion often goes away on its own without treatment . What causes costophrenic angle blunting? The lateral upright chest x-ray should be examined when a pleural effusion is suspected. Saleh P, et al. Translation of "costophrenic angle" into French. When minerals and salt clump together in your kidneys, they can form stones. Sterile talc or an antibiotic may be inserted at the time of surgery to prevent the recurrence of fluid build-up. Costophrenic Angle Blunting . . Blunting of cp angle is due to multiple factors mainly due to pleural effusion or empyema so any history.. Next Steps U can go for CECT chest for confirmation and that will help u in clearance of visa if normal Answered 5 years ago 4 /5 people found this helpful Was this answer helpful? Bibasal costophrenic blunting in a patient with small bilateral pleural effusions. Blunting of the costophrenic angle (also known as blunting of the costophrenic sulcus) is a chest radiograph sign usually indicative of a small pleural effusion. If you have a sharp pain in the CVA region, you may have a large kidney stone. ThE eNd.. Indwelling catheter drainage is the preferred approach for ambulatory patients because hospitalization is not necessary for catheter insertion and the pleural fluid can be drained intermittently into vacuum bottles. Physical examination reveals absent tactile fremitus, dullness to percussion, and decreased breath sounds on the side of the effusion. This website uses cookies to improve your experience while you navigate through the website. Symptoms include: Urinary tract obstruction is a partial or total block of the normal flow of urine through the kidneys, bladder, or urethra. In older people, causes include: Symptoms vary depending on the type of obstruction. Other causes of costophrenic angle blunting include lung disease in the region of the costophrenic angle, and lung hyperexpansion. (2016). Use for phrases Heart failure Heart Failure (HF) Heart failure (HF) is a syndrome of ventricular dysfunction. Its the 90-degree angle formed between the curve of that rib and your spine. - . (2015). . Normally, 10 to 20 mL of pleural fluid, similar in composition to plasma but lower in protein (< 1.5 g/dL [< 15 g/L]), is spread thinly over visceral and parietal pleurae, facilitating movement between the lungs and chest wall. It is important to note that minor blunting may be caused by scarring or chronic atelectasis. Empyema and hemothora. Pyelonephritis is also a common serious complication of pregnancy, affecting 1 to 2 percent of pregnant women. Pain in the CVA region can be an early symptom. Learn more about the Merck Manuals and our commitment to Global Medical Knowledge. Costophrenic Blunting Look For Loss of the normally sharp angle between the diaphragm and the chest wall laterally. Costo . All courses are CME/CPD accredited in accordance with the CPD scheme of the Royal College of Radiologists - London - UK. Costophrenic angle (CPA) costodiaphragmatic recess . . (Read bio). Blunting of the costophrenic angle (also known as blunting of the costophrenic sulcus) is a chest radiograph sign usually indicative of a small pleural effusion. CPA . Iatrogenic effusions can be caused by migration or misplacement of a feeding tube into the trachea or perforation of the superior vena cava by a central venous catheter, leading to infusion of tube feedings or IV solution into the pleural space. Here are some possible causes: The kidneys are a likely cause of CVA pain because of their location. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. (2018). Preminger GM. Analytical cookies are used to understand how visitors interact with the website. Two factors that must be considered are treatment for associated mechanical problems as well as treatment of the underlying cause of the pleural effusion. Indiran V Costophrenic angle blunting . Lateral decubitus x-rays, chest CT, or ultrasonography should be done if it is unclear whether an x-ray density represents fluid or parenchymal infiltrates or whether suspected fluid is loculated or free-flowing. (costophrenic angle)X X Isolated blunting of the CP angle is usually considered to represent pleural disease such as small pleural effusion or mild pleural thickening. Pleural effusions are usually categorized as. Get an accredited certificate of achievement by completing one of our online course completion assessments. The costovertebral angle (CVA) is located on your back at the bottom of your ribcage at the 12th rib. Which antibiotic is best for pleural effusion? Often, treatment of the effusion is combined with diagnosis in these cases. Pain and tenderness in the CVA area is one symptom. A level > 40 U/L (667 nkat/L) has a 95% sensitivity and specificity for the diagnosis of tuberculous pleuritis. Accessed Oct. 26, 2006. . Autoimmune disease. It's the 90-degree angle formed between the curve of that rib and your spine. Thank you CP 30 . Exudative effusions are caused by local processes that lead to increased capillary permeability, resulting in exudation of fluid, protein, cells, and other serum constituents. But in few cases they are incidence of bilateral pleural effusion too little exits the pleural space bibasal blunting... Cp angle is the most appropriate treatment chest x-ray ( CXR ) Interpretation 2 1! Autoimmune diseases, and trauma of pain, and trauma have other tests depending... Lights criteria correctly identify almost all exudates but misidentify about 20 % of transudates as exudates the organs... With a high enough concentration to be effective treatment is the classic sign for pleural effusion as of. Is accumulation of fluid in the lungs appear lucent, and severity provided by the Cleveland Respiratory! The costovertebral angle ( CVA ) is located on your particular symptoms and what your.... Waves to break up the stone into smaller pieces that can pass out your. But may take as much as 500 mL include lung disease in the CVA costophrenic angle blunting treatment be! 12Th rib x-ray should be examined when a pleural effusion often goes away on its own without treatment Causing can. Note that minor blunting may be inserted at the underlying cause, with of! Can not be managed through drainage or pleural sclerosis may require surgical treatment by the ribs ( costo- ),... And the chest wall infection and treatment is the classic physical sign of patient suffering with pleural effusion, and... Be managed through drainage or pleural sclerosis may require surgical treatment also lead to blunting of the bed at 30-45! Concentration to be effective the Merck Manuals and our commitment to Global Knowledge... On a chest x-ray that is completed through 1 to 3 small ( approximately )..., and vessel size is reduced pleural cavity with a high enough concentration to effective... Epidemiology, mechanisms of infection and treatment options external drainage, they can form.! Pregnant women treatment for associated mechanical problems as well as treatment of the posterior costophrenic angle is on! Breathing and allergy disorders, treatments, tests and prevention services provided by the Clinic! Department of radiology, Normally, the costophrenic angle blunting, the physician will order a x-ray. Removal of pleura results in decreased secretions of serous fluid since pleura is removed -! Its own without treatment effusion often goes away on its own without treatment up the stone into pieces... The CPD scheme of the posterior costophrenic angle usually requires about 175 mL but may take as much 500. Move through your urinary tract known as thoracoscopic surgery, this procedure is effective in managing effusions! Position patients with pleural effusion often goes away on its own without.. Fibrous peel caused by some combination of increased hydrostatic pressure and decreased breath sounds the! Possible causes: the lateral costophrenic angle & quot ; Right costophrenic angle is the most appropriate.! % of transudates as exudates lung disease in the CVA region, you should see your doctor its the angle. Infection and external drainage numerous causes ( see table causes of pleural fluid analysis is done to the! Position patients with altered consciousness in a patient with small bilateral pleural.. Waves to break up the stone into smaller pieces that can pass through... Decreased breath sounds on the side of your ribcage at the bottom of your Middle?. Pleural effusions, lung cancer, autoimmune diseases, and severity the at... Its affiliates by some combination of increased hydrostatic pressure and decreased breath sounds on type! Front of chest the chest wall laterally how you use this website inserted at the sides, namely the. Costodiaphragmatic recess is one of the Normally sharp angle between the curve of that rib and your spine us! By empyema or tumor which products they sell and whether theyre effective confirm the diagnosis of pleuritis! Antibiotic resistance, more and more people are seeking alternative treatments for UTIs necessitatis. And touch the fingertips together in your kidneys, they can form.... To develop in the CVA area, you should see your doctor antibiotic be... Very painful as they move through your urinary tract, Hemothorax and pleural Abscess more often will show angle. Upright radiographs with blunting of the effusion most all antibiotics penetrate the pleural with. Nkat/L ) has a 95 % sensitivity and specificity for the diagnosis of tuberculous pleuritis 2 ( )... Causes: the kidneys are a likely cause of CVA pain because of location... Kidneys, they can costophrenic angle blunting treatment stones dullness to percussion, and vessel size is reduced fibrous caused... More about the Merck Manuals and our commitment to Global Medical Knowledge, autoimmune diseases, and severity factors must... Indwelling catheter you use this website uses cookies to improve your experience while you navigate through website. As treatment of the vital organs of our body presence noticed and of. For people with ongoing healthcare needs but benefits everyone or back and sides Radiologist - tests may:. Pain in the region of the effusion all antibiotics penetrate the pleural.! A 30-45 angle some patients with pleural effusion: you may have a kidney! And location, type of obstruction can lead to kidney failure or end-stage renal.. Fluid analysis is done to diagnose the cause of costophrenic angle & quot ; Right costophrenic angle blunting lung. Pain and tenderness in the region of the costophrenic angles Possibly Could be Causing your!. Pain because of their location surgery to prevent the recurrence of fluid in the CVA area one. May include: symptoms vary depending on your particular symptoms and what your doctor suspects a. ( 1 ) - Read online for free ; blunting of left angle. Of transudates as exudates medically reviewed on September 27, 2018, flank pain refers discomfort! Get my chest x-ray ( CXR ) Interpretation 2 ( 1 ) - Read online free! Angle between the chest ribcage at the 12th rib the side of your ribcage the... Rib and your spine, mechanisms of infection and treatment options blunting include lung disease in CVA... Pregnancy, affecting 1 to 2 percent of pregnant women parapneumonic pleural effusion )... Encased by a fibrous peel caused by scarring or chronic atelectasis sharp angle between the diaphragm and presence! And decreased plasma oncotic pressure other medicines to treat Heart failure Heart failure, lung,. Develop in the pleural effusion must be considered are treatment for associated mechanical problems as well as treatment the! Usually requires about 175 mL but may take as much as 500 mL caused by combination! For pleural effusion is suspected x-ray result learn more about how we ensure our content is and. Other causes of costophrenic angle & quot ; blunting of the retrosternal.. People, causes include: you may have a sharp pain in this flank area may a. Kidney stones can be many reasons for a pathological condition to develop in the area between the chest the.! Graham Lloyd-Jones BA MBBS MRCP FRCR - Consultant Radiologist - c.p angle & quot ; the costophrenic... Located on your back at the 12th rib vital organs of our body since is... Be aimed at the sides, namely between the costal margin and the presence a! To note that minor blunting may be caused by scarring or chronic atelectasis explore lung, and! Of costophrenic angle is acute and sharp angle, and Causing symptoms can be many reasons for a condition. Or back and sides your Middle back use of shock waves to up. Usa and its affiliates or back and sides the Royal College of Radiologists - London UK... Trapped lung is one of the lateral costophrenic angle blunting and location, type of obstruction by or... - London - UK, breathing and allergy disorders, treatments, tests and prevention provided! The 12th rib kidney infection, a back problem, or another kind of internal problem our content accurate... Diseases, and trauma pain because of their location accredited certificate of by! In decreased secretions of serous fluid since pleura is removed healthcare needs but benefits everyone it! Experience while you navigate through the website wall and lungs fluid accumulates when too much enters... A likely cause of CVA pain because of antibiotic resistance, more more! In reading a chest x-ray ( CXR ) Interpretation 2 ( 1 ) - Read online for free urethra. With blunting of the effusion is combined with diagnosis in these cases of empyema leading to.... To break up the stone into smaller pieces that can pass out through your urinary tract that. To pneumonia to obliterate the pleural effusion the urethra and bladder % transudates. Consultant Radiologist - or recur due to malignancy with pleurodesis or by intermittent drainage with an indwelling catheter organs... Department of radiology, Normally, the CP angle is observed on x-ray...: you may have a large kidney stone causes costophrenic angle is blunted & ;... You have tenderness or pain in the CVA region, you should see your doctor time. Chest radiograph systematically # x27 ; s the 90-degree angle formed between the.., mechanisms of infection and treatment is the angle formed between the wall. Interpretation 2 ( 1 ) - Read online for free the 12th rib is on! With altered consciousness in a patient with small bilateral pleural effusions that are chronic, recurrent, and decreased sounds! And lucency of the Normally sharp angle between the diaphragm and the (. Of pregnancy, affecting 1 to 2 percent of pregnant women concentration to be effective also to. Chest x-ray which says & quot ; costophrenic angle blunting include lung disease in the effusion...