The costodiaphragmatic recess, also called the costophrenic recess or phrenicocostal sinus,
Retrieved May 2011 is the posterolateral fringe of the pleural space
The pleural cavity, pleural space, or interpleural space is the potential space between the pleurae of the pleural sac that surrounds each lung. A small amount of serous pleural fluid is maintained in the pleural cavity to enable lubrication bet ...
, a potential space
In anatomy, a potential space is a space between two adjacent structures that are normally pressed together (directly apposed). Many anatomic spaces are potential spaces, which means that they are potential rather than realized (with their realiz ...
around the lung
The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either side of t ...
inside the pleural cavity
The pleural cavity, pleural space, or interpleural space is the potential space between the pleurae of the pleural sac that surrounds each lung. A small amount of serous pleural fluid is maintained in the pleural cavity to enable lubrication bet ...
. It is located at the acutely angled junction ("reflection") between the costal and diaphragmatic pleurae, and is interpreted two-dimensional
In mathematics, a plane is a Euclidean (flat), two-dimensional surface that extends indefinitely. A plane is the two-dimensional analogue of a point (zero dimensions), a line (one dimension) and three-dimensional space. Planes can arise as s ...
ly on plain X-ray
Projectional radiography, also known as conventional radiography, is a form of radiography and medical imaging that produces two-dimensional images by X-ray, x-ray radiation. The image acquisition is generally performed by radiographers, and the i ...
s as the costophrenic angle. It measures approximately vertically and extends from the eighth to the tenth rib
In vertebrate anatomy, ribs ( la, costae) are the long curved bones which form the rib cage, part of the axial skeleton. In most tetrapods, ribs surround the chest, enabling the lungs to expand and thus facilitate breathing by expanding the ches ...
along the mid-axillary line
The axillary lines are the anterior axillary line, midaxillary line and the posterior axillary line.
The anterior axillary line
is a coronal line on the anterior torso marked by the anterior axillary fold. It's the imaginary line that runs dow ...
.
Function
The lungs
The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either side of th ...
expand into this recess during forced inspiration
Inspiration, inspire, or inspired often refers to:
* Artistic inspiration, sudden creativity in artistic production
* Biblical inspiration, the doctrine in Judeo-Christian theology concerned with the divine origin of the Bible
* Creative inspirat ...
; however, the recess never gets filled completely. During expiration, it contains nothing apart from gravitated serous fluid
In physiology, serous fluid or serosal fluid (originating from the Medieval Latin word ''serosus'', from Latin ''serum'') is any of various body fluids resembling Serum (blood), serum, that are typically pale yellow or transparent and of a benign ...
.
Clinical significance
Pleural effusion
A pleural effusion is accumulation of excessive fluid in the pleural space, the potential space that surrounds each lung.
Under normal conditions, pleural fluid is secreted by the parietal pleural capillaries at a rate of 0.6 millilitre per kilog ...
s collect in the costodiaphragmatic recess when in standing position
Anatomical terminology is a form of scientific terminology used by anatomists, zoologists, and health professionals such as doctors.
Anatomical terminology uses many unique terms, suffixes, and prefixes deriving from Ancient Greek and Latin. The ...
,[ and present on ]plain X-ray
Projectional radiography, also known as conventional radiography, is a form of radiography and medical imaging that produces two-dimensional images by X-ray, x-ray radiation. The image acquisition is generally performed by radiographers, and the i ...
s as "blunting" of the costophrenic angle.
A thoracocentesis
Thoracentesis , also known as thoracocentesis (from Greek ''thōrax'' 'chest, thorax'—GEN ''thōrakos''—and ''kentēsis'' 'pricking, puncture'), pleural tap, needle thoracostomy, or needle decompression (often used term), is an invasive med ...
(pleural tap) is often performed here while a patient is in full expiration because of less risk of puncturing the lungs and thereby causing pneumothorax
A pneumothorax is an abnormal collection of air in the pleural space between the lung and the chest wall. Symptoms typically include sudden onset of sharp, one-sided chest pain and shortness of breath. In a minority of cases, a one-way valve ...
.[drugs.com > costodiaphragmatic-recess]
Retrieved May 2011
Imaging
In anatomy
Anatomy () is the branch of biology concerned with the study of the structure of organisms and their parts. Anatomy is a branch of natural science that deals with the structural organization of living things. It is an old science, having its ...
, the costophrenic angles are the places where the diaphragm
Diaphragm may refer to:
Anatomy
* Thoracic diaphragm, a thin sheet of muscle between the thorax and the abdomen
* Pelvic diaphragm or pelvic floor, a pelvic structure
* Urogenital diaphragm or triangular ligament, a pelvic structure
Other
* Diap ...
(''-phrenic'') meets the ribs (''costo-'').
Each costophrenic angle can normally be seen as on chest x-ray
A chest radiograph, called a chest X-ray (CXR), or chest film, is a projection radiograph of the chest used to diagnose conditions affecting the chest, its contents, and nearby structures. Chest radiographs are the most common film taken in med ...
as a sharply-pointed, downward indentation (dark) between each hemi-diaphragm (white) and the adjacent chest wall (white). A small portion of each lung normally reaches into the costophrenic angle. The normal angle usually measures thirty degrees.
Pleural effusion
With pleural effusion
A pleural effusion is accumulation of excessive fluid in the pleural space, the potential space that surrounds each lung.
Under normal conditions, pleural fluid is secreted by the parietal pleural capillaries at a rate of 0.6 millilitre per kilog ...
, fluid often builds up in the costophrenic angle (due to gravity). This can push the lung upwards, resulting in "blunting" of the costophrenic angle.
The posterior angle is the deepest.
Obtuse angulation is sign of disease.
Chest x-ray is the first test done to confirm the presence of pleural fluid. The lateral upright chest x-ray should be examined when a pleural effusion is suspected. In an upright x-ray, 75 mL of fluid blunts the posterior costophrenic angle. Blunting of the lateral costophrenic angle usually requires about 175 mL but may take as much as 500 mL. Larger pleural effusions opacify portions of the hemithorax and may cause mediastinal shift; effusions > 4 L may cause complete opacification of the hemithorax and mediastinal shift to the contralateral side.
See also
* Thoracentesis
Thoracentesis , also known as thoracocentesis (from Greek ''thōrax'' 'chest, thorax'—GEN ''thōrakos''—and ''kentēsis'' 'pricking, puncture'), pleural tap, needle thoracostomy, or needle decompression (often used term), is an invasive med ...
References
External links
*
Diagram (Question #4, item E)
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Pleura