Typically, chest radiograph in early stage shows bilateral and symmetric micronodular or reticulonodular shadow predominantly in mid and upper lung zones with sparing of costophrenic angles
. Initially, nodules and cysts may appear in conjunction and as the disease advances nodules become infrequent and cystic lesions predominate.
(c) On chest X-ray, the costophrenic angles
were closed with appearance of hydrothorax.
All imaging was acquired in a single breath hold in a caudocranial direction, started from the posterior costophrenic angles
and ends at the lung apex.
On the pulmonary radiograph the bilateral costophrenic angles
were obscured and there was bilateral paracardiac infiltration.
(3) As the disease progresses, the Langerhans cells recede from the end stage, fibrotic areas which then appear as hypocellular, stellate shaped scars and variable cysts in the pulmonary parenchyma that give rise to the radiologic features (Figure 1).2,3 CT demonstrates nodules, reticular changes and in advanced disease, peribronchiolar irregularly shaped cysts of variable sizes in upper and middle lobes with characteristic sparing of the costophrenic angles
. (1-3) (Figure 1: Bottom left and bottom right).
A chest radiograph demonstrated bilateral alveolar and interstitial opacities, blunting of the costophrenic angles
bilaterally, and bilateral pleural effusions.
These angles are named after their location: hence the term costophrenic angles
. (See Figure 4.) The right and left costophrenic angles
are important radiographically because they can be used to detect effusions and other abnormalities.
Chest X-ray postero-anterior view showed homogeneous round opacity in right lower zone with blunting of right costophrenic angles
A chest radiograph obtained at presentation revealed bilateral reticulonodular infiltration with upper and middle lung predominance and obliteration of the bilateral costophrenic angles
A chest X-ray showed bilateral lower and mid zone haziness with obliteration of costophrenic angles
(picture of plural effusion).
The anatomy best demonstrated on this projection of the lateral chest is the entire lungs from the apices to the costophrenic angles
, and from the sternum anteriorly to posterior ribs and thorax posteriorly."
The X-ray chest PA and Lateral views (Fig-1a, b) revealed fibrocalcific lesions with haziness in both mid and upper zones with multiple calcific lesions in both hilar and perihilar regions and blunting of both costophrenic angles
suggestive of Pulmonary Koch's with calcified lymphadenopathy and associated pleural pathology.