Complete pleural symphysis is predicted by a blunted costophrenic angle

Area of Science:

• Thoracic Surgery
• Pulmonary Medicine
• Diagnostic Imaging

Background:

• Complete pleural symphysis due to adhesions is a frequent intraoperative complication.
• A blunted costophrenic angle on imaging suggests prior pleural disease but its diagnostic value for symphysis is uncertain.

Purpose of the Study:

• To determine if a blunted costophrenic angle predicts complete pleural symphysis.
• To assess the diagnostic accuracy of blunted costophrenic angles for complete pleural symphysis.

Main Methods:

• Retrospective review of 1204 thoracic surgery cases, excluding those with preoperative pleural effusion.
• Receiver-operating characteristic (ROC) curve analysis to identify the optimal costophrenic angle cut-off (51°) for predicting symphysis.
• Calculation of sensitivity, specificity, accuracy, and likelihood ratios for blunted vs. sharp costophrenic angles.

Main Results:

• A blunted costophrenic angle (≤51°) was significantly associated with complete pleural symphysis (p < 0.001).
• Diagnostic performance included 70.7% sensitivity, 96.1% specificity, and 95.3% accuracy.
• Positive and negative likelihood ratios were 18.3 and 0.30, respectively.

Conclusions:

• A blunted costophrenic angle is a reliable predictor of complete pleural symphysis.
• This finding offers moderate sensitivity but high specificity and accuracy.
• Costophrenic angle evaluation is a simple, convenient, and efficient screening tool for intraoperative adhesions.