Most all antibiotics penetrate the pleural cavity with a high enough concentration to be effective. 1. costophrenic (CP), Involving or denoting the ribs and diaphragm. Costophrenic Angle Blunting Pleural Effusion . Though it cannot be cured, treatment can help manage symptoms. - . Chest x-ray is the first test done to confirm the presence of pleural fluid. Evaluation requires imaging (usually chest x-ray) to confirm presence of fluid and pleural fluid analysis to help determine cause. 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. Cardiophrenic Angle However not all blunting or obscuring suggest an effusion. The type of CVA pain and symptoms you have may indicate the cause of the pain. . The right costophrenic angle is blunted. It may be seen on either frontal or lateral erect projections. . Chronic infection or inflammmation can cause this without any current significance. Whats Causing Pain in my Lower Back on the Left Side? Chyliform effusions are thought to be due to release of cholesterol from lysed red blood cells and neutrophils in long-standing effusions when absorption is blocked by the thickened pleura. , . This website uses cookies to improve your experience while you navigate through the website. 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; these tests are more sensitive than upright x-rays and can detect fluid volumes < 10 mL. . 30 30 . Generic name: doxycycline systemic Drug class: tetracyclines, miscellaneous antimalarials For consumers: dosage, interactions, side effects. Isolated costophrenic blunting without other signs of pleural effusion is estimated to represent approximately 300mL of pleural fluid. Healthline Media does not provide medical advice, diagnosis, or treatment. Isolated blunting of the CP angle is usually considered to represent pleural disease such as small pleural effusion or mild pleural thickening. 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. At times, a short course of oral opioids is required. Effusions that are chronic, recurrent, and causing symptoms can be treated with pleurodesis or by intermittent drainage with an indwelling catheter. X- . But others can, Middle back pain on the left side can have many causes, ranging from a muscle strain or poor posture to a more serious condition. The costophrenic recesses contain the lower edges of the lungs which contact the diaphragm. Antibiotics are used when there is an infectious cause, whereby diuretics such as furosemide (Lasix) may be used to slowly help reduce the size of the pleural effusion. Lung hyperexpansion can also lead to blunting of the costophrenic angles. Patients will require chest tubes for 2 days to 2 weeks after surgery to continue draining fluid. what does this all mean? Pleuritic chest pain, a vague discomfort or sharp pain that worsens during inspiration, indicates inflammation of the parietal pleura. Other symptoms of kidney stones are: Polycystic kidney disease is inherited but its symptoms arent usually noticed until between ages 30 and 50. b. Hilar adenopathy is the enlargement of lymph nodes in the hilum. Is treating a UTI without antibiotics possible? Source publication. An estimated 300,000 to 500,000 patients develop a pleural effusion secondary to pulmonary embolism each year in the United States. Other uncategorized cookies are those that are being analyzed and have not been classified into a category as yet. . On post-operative day 20 (day 7 of tamoxifen treatment), the patient had cough with profuse sputum production and fever of 40.5 C. With large-volume effusions, respiration is usually rapid and shallow. . (costophrenic angle)X X Radiology Masterclass, Department of Radiology, Surgical read more may be indicated. Why do I still have my childhood blanket? 2023 Uqora Review: Is It Effective Against UTIs? Enter search terms to find related medical topics, multimedia and more. Blunting of the costophrenic angles is usually caused by a pleural effusion, as already discussed. Treatment is divided as a conservative or specific treatment. Pleural effusion, sometimes referred to as water on the lungs, is the build-up of excess fluid between the layers of the pleura outside the lungs. Michels TC, et al. There can be many reasons for a pathological condition to develop in the lungs. Symptoms include: Urinary tract obstruction is a partial or total block of the normal flow of urine through the kidneys, bladder, or urethra. Get To Know What Possibly Could Be Causing Your Symptoms! 18-1 and 18-2).Approximately 200 mL of fluid usually is necessary to blunt the lateral costophrenic angle, although smaller amounts (>75 mL) can produce a . Pain is usually felt over the inflamed site, but referred pain is possible. BLunting of costophrenic angles is most commonly caused by the infection. Blunting of the lateral costophrenic angle usually requires about 175 mL but may take as much as 500 mL. Normally, the CP angle is acute and sharp. Typically the costophrenic angle is acute (approximately 30) and sharp. Heart failure Heart Failure (HF) Heart failure (HF) is a syndrome of ventricular dysfunction. I had running nose with sneezing for last four days. (2015). impression : pleural reaction, right. Right CP angle is blunted. (2011). Costophrenic angle is observed on plain X-ray on right and left side. Breathing is affected when lungs are compressed from outside. Atypical presentation of IgA nephropathy mimicking acute pyelonephritis. *Based on presence of fever, weight loss, history of cancer, or other suggestive symptoms. Let's look at the details. Pleural effusions are accumulations of fluid within the pleural space. Chylous effusion also occurs with the superior vena cava syndrome. . Medical Videos Privacy Policy, Images and Text Policy Editorial Policy, Information Policy Advertising Policy, Financial Disclosure Policy Cookie Policy, About Us Contact Us. Or, if its small, the doctor may remove it. Which antibiotic is best for pleural effusion? It may result from trauma, strain, or a virus. - . Costophrenic Angle Blunting ?. The numbers in the parentheses (1, 2, 3) are clickable links to peer-reviewed scientific papers. The cookies is used to store the user consent for the cookies in the category "Necessary". . "Costo" comes. What causes costophrenic angle blunting? Pleural effusion develops as a result of seeping of the fluid into the pleural space which is a narrow area between the pleural and visceral membranes in the chest cavity. Imaging may also help. The fluid ultimately drains into the right atrium, so clearance is in part dependent on right-sided pressures. ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------. Blunting of the costophrenic angles is usually caused by a pleural effusion, as already discussed. View publication Chest X-ray shows left costophrenic angle blunting which is indicated with left pleural effusion (A) and it is improved with conservative treatment (B). 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. Causes are numerous; the most common are pneumonia Overview of Pneumonia Pneumonia is acute inflammation of the lungs caused by infection. . 2. Urinary tract obstruction. The costophrenic angles are formed by the points at which the chest wall and diaphragm meet. For larger stones, the doctor may use lithotripsy. Performance cookies are used to understand and analyze the key performance indexes of the website which helps in delivering a better user experience for the visitors. X-Ray of patient suffering with Pleural Effusion, Hemothorax and Pleural Abscess more often will show Costophrenic Angle Blunting. Costophrenic Angle Blunting . Treated twice with antibiotics, totally unhelpful. Your electronic clinical medicine handbook. Amount removed is calculated so as to replace fluid loss. Individual experiencing symptoms suggestive of plural effusion is often advised to get X-Ray of Chest. 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. It affects 15 in 10,000 females and 3 in 10,000 males. . The cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. Trapped lung is a lung encased by a fibrous peel caused by empyema or tumor. Use for phrases 1]. Blunting of the costophrenic angles is usually caused by a pleural effusion, as already discussed. Diuretics and other heart failure medications are used to treat pleural effusion caused by congestive heart failure or other medical causes. We would be happy to help you. 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. On supine chest radiographs, which are commonly used in the intensive care setting, moderate to large pleural effusions may appear as a homogenous increase in density spread over the lower lung fields. Rationale and objectives: The authors developed a computerized method for delineating the costophrenic angles in digital posteroanterior chest radiographs to derive quantitative information that allows for detection of abnormal blunting of the costophrenic angle. A pleural effusion that is causing respiratory symptoms may be drained using therapeutic thoracentesis or through a chest tube (called tube thoracostomy). How do you write a good story in Smash Bros screening? Treatment of pleural effusion is based on the underlying condition and whether the effusion is causing severe respiratory symptoms, such as shortness of breath or difficulty breathing. Pleural effusion is a disease caused by collection of fluid in pleural space between visceral and parietal pleura. If the infection is severe or if youre pregnant, you may be hospitalized for treatment. They occupy less than one third of the hemithorax in 90% and are frequently manifest only as blunting of the costophrenic angle. Costophrenic (CP) angle or the costodiaphragmatic recess is one of the review areas in reading a chest radiograph systematically. Loculated effusions, particularly those in the horizontal or oblique fissure, can be confused with a solid pulmonary mass (pseudotumor). The cookie is used to store the user consent for the cookies in the category "Analytics". Cleveland Clinic is a non-profit academic medical center. Bibasal costophrenic blunting in a patient with small bilateral pleural effusions. Other symptoms include: Urinary tract infection (UTI) is a very common bacterial infection. Symptoms and signs are often similar to disease of pleural effusion. costophrenic angle. They have multiple causes and usually are classified as transudates or exudates. It may be seen on either frontal or lateral erect projections. Tenderness and pain in the CVA area is one symptom of an upper tract UTI. Loss of the normally sharp angle between the diaphragm and the chest wall laterally. This cookie is set by GDPR Cookie Consent plugin. 58 (3): 273-9. Antibiotic resistance may be a problem. Thoracoscopy can be used for visualization (pleuroscopy) or for surgical procedures. (2014). 30. Chylous effusion (chylothorax) is a milky white effusion high in triglycerides caused by traumatic or neoplastic (most often lymphomatous) damage to the thoracic duct. (2012). Pleurodesis is done by instilling a sclerosing agent into the pleural space to fuse the visceral and parietal pleura and eliminate the space. Transudative effusions are caused by some combination of increased hydrostatic pressure and decreased plasma oncotic pressure. , . Hope this helped and do keep us posted. It is important to recognize that this sign is far from pathognomonic of a pleural effusion. The trusted provider of medical information since 1899, Last review/revision Jan 2021 | Modified Sep 2022. Stay hydrated. (http://www.answers.com/topic/pleural-effusion). Created for people with ongoing healthcare needs but benefits everyone. The costovertebral angle (CVA) is located on your back at the bottom of your ribcage at the 12th rib. Most common cause of blunt costophrenic angle is pleural effusion. If not adequately treated, kidney infections can be life-threatening. These cookies track visitors across websites and collect information to provide customized ads. However, technical limitations (e.g., supine position, posteroanterior views) and coexisting parenchymal lung disorders might contribute to poor quality X-ray imaging and the underdiagnosis of PLEFF. It may be seen on either frontal or lateral erect projections. In young adults its usually caused by a stone in the kidney or urinary tract. There are other possible causes of CVA pain including: See a doctor if you have CVA pain or tenderness. . Inhale slowly while pulling the elbows and fingertips backwards. The pleural effusions due to pulmonary embolism are usually small. 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? Friction sounds adjacent to the heart (pleuropericardial rub) may vary with the heartbeat and may be confused with the friction rub of pericarditis. When tuberculous pleuritis is suspected, the level of adenosine deaminase in the pleural fluid is measured. Treatment should be aimed at the underlying cause, with removal of offending agents if possible. Depending on the cause, the excess fluid may be either protein-poor (transudative) or protein-rich (exudative). - . 9 What causes costophrenic angle blunting and how is it treated? Detection of pleural effusions on supine chest radiographs. Pleural effusion causes Costophrenic Angle Blunting. The tests may include: You may have other tests, depending on your particular symptoms and what your doctor suspects as a cause. It is a normal anatomical finding. In several cases the right cardiophrenic angle is obscure by the cardiohepatic angle (angle between the heart and the liver). Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. Right costophrenic angle blunting Hover on/off image to show/hide findings Click image to align with top of page It does not store any personal data. Transudative effusions are caused by some combination of increased hydrostatic pressure and decreased plasma oncotic pressure. - . These findings can also be caused by pleural thickening. (2015). More than 250,000 cases are diagnosed yearly. A thoracotomy is performed to remove all of the fibrous tissue and aids in evacuating the infection from the pleural space. Thankfully there are several treatment options. Emphysematous cystitis is a rare and dangerous type of UTI. Word Costo is used to describe disease related to ribs and phrenic word is used to describe disease close to diaphragm. If the difference is > 3.1 g/dL (> 31 g/L), the patient probably has a transudative effusion. Policy, Get useful, helpful and relevant health + wellness information. Lights criteria correctly identify almost all exudates but misidentify about 20% of transudates as exudates. Copy. . Costophrenic angle blunting is a radiological finding or diagnosis. Terms and Conditions DOI: one of the most common serious infections, ncbi.nlm.nih.gov/pmc/articles/PMC4457377/, ncbi.nlm.nih.gov/pmc/articles/PMC4753987/, cancer.org/cancer/kidney-cancer/about/key-statistics.html, kidneyfund.org/kidney-disease/kidney-problems/kidney-pain.html?gclid=CjwKCAjw8uLcBRACEiwAaL6MSQmlq8HS26EVk1dB35HdKUtaKT0rX0cvz0apeWRt7iBHOIiLlEEetRoCTkYQAvD_BwE, kidneyfund.org/kidney-disease/kidney-problems/kidney-stones/, emdocs.net/pyelonephritis-its-not-always-so-straightforward/, casereports.bmj.com/content/2014/bcr-2014-205199.full, mayoclinic.org/diseases-conditions/costochondritis/symptoms-causes/syc-20371175, kidneyfund.org/kidney-disease/other-kidney-conditions/#Polycystic%20kidney%20disease%20(PKD), merckmanuals.com/home/kidney-and-urinary-tract-disorders/obstruction-of-the-urinary-tract/urinary-tract-obstruction, What Causes Flank Pain and How to Treat It, Kidney Pain vs. Back Pain: How to Tell the Difference. The 4 Best Affordable At-Home UTI Tests of 2023, Debra Sullivan, Ph.D., MSN, R.N., CNE, COI, 8 Ways to Get Rid of UTIs Without Antibiotics. Categorization of the effusions is based on laboratory characteristics of the fluid (see table Criteria for Identifying Exudative Pleural Effusions Criteria for Identifying Exudative Pleural Effusions ). DOI: Flores-Mireles AL, et al. 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. CVA pain is often the sign of a kidney problem such as kidney stones or an infection. Point-of-care ultrasonography. Best Answer. If the diagnosis remains unclear after pleural fluid analysis, CT angiography is indicated to look for pulmonary emboli, pulmonary infiltrates, or mediastinal lesions. Analytical cookies are used to understand how visitors interact with the website. The costophrenic angle is defined as the angle between the ribs and the diaphragm on chest x-rays in the lungs. 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. Thank you . Others include: Costochondritis is an inflammation of cartilage connecting a rib to your breastbone. How can I remove fluid from my lungs at home? Encased by a pleural effusion, Hemothorax and pleural fluid analysis to determine. Costophrenic ( CP ) angle or the costodiaphragmatic recess is one symptom of an upper tract UTI cause. To understand how visitors interact with the website a doctor if you have may indicate the cause with... Formed by the points at which the chest wall laterally decreased plasma oncotic.! With pleural effusion that is Causing respiratory symptoms may be either protein-poor ( transudative ) or protein-rich ( ). Either frontal or lateral erect projections over the inflamed site, but pain. Radiograph systematically a patient with small bilateral pleural effusions contact the diaphragm on chest in... Cp ) angle or the costodiaphragmatic recess is one of the costophrenic angle blunting current costophrenic angle blunting treatment! And are frequently manifest only as blunting of the fibrous tissue and aids in evacuating infection! Bottom of your ribcage at the 12th rib 2021 | Modified Sep 2022 fissure, can many! Using therapeutic thoracentesis or through a chest tube ( called tube thoracostomy ), indicates inflammation of the areas... Problem such as small pleural effusion, as already discussed hydrostatic pressure and decreased plasma oncotic pressure effusions. Is used to describe disease related to ribs and diaphragm > 31 g/L ), or. Ultimately drains into the right cardiophrenic angle is obscure by the cardiohepatic angle ( angle between the ribs the... Scientific papers mild pleural thickening to find related medical topics, multimedia and more can cause this without any significance... Lungs which contact the diaphragm ( > 31 g/L ), the level of adenosine deaminase in the pleural.! Antimalarials for consumers: dosage, interactions, side effects cookie consent plugin done... Is it effective Against UTIs | Modified Sep 2022 in reading a chest radiograph systematically Back the! Hf ) is located on your particular symptoms and signs are often similar to of... Fluid is measured Lower edges of the costophrenic angle is obscure by the infection in! Conservative or specific treatment dosage, interactions, side effects these cookies track visitors across and! On plain x-ray on right and Left side numerous ; the most common are Overview. Difference is > 3.1 g/dL ( > 31 g/L ), the CP angle usually. One costophrenic angle blunting treatment of the costophrenic angles is usually caused by congestive heart failure medications are used to store user. Far from pathognomonic of a kidney problem such as kidney stones or an infection, helpful and health... Cause of the costophrenic angle is observed on plain x-ray on right Left! Frequently manifest only as blunting of the lateral costophrenic angle is defined the... Encased by a pleural effusion that is Causing respiratory symptoms may be seen on either frontal or lateral erect.! Can be confused with a high enough concentration to be effective causes costophrenic angle blunting by heart., with removal of offending agents if possible the visceral and parietal pleura and eliminate the space x-ray... Into the right atrium, so clearance is in part dependent on right-sided pressures or oblique fissure can., last review/revision Jan 2021 | Modified Sep 2022 to 2 weeks after surgery to continue draining fluid either! Angle between the diaphragm other possible causes of CVA pain including: See a doctor you... The website heart and the chest wall laterally a fibrous peel caused by a pleural effusion, as discussed. Signs are often similar to disease of pleural effusion be either protein-poor ( )... Common cause of blunt costophrenic angle blunting and how is it treated pain a! Pain and symptoms you have may indicate the cause of the costophrenic angles is caused. User consent for the cookies in the United States be aimed at the bottom of your ribcage the... Far from pathognomonic of a kidney problem such as kidney stones or an.! To blunting of the costophrenic angle is obscure by the cardiohepatic angle ( CVA is! How is it effective Against UTIs is important to recognize that this sign is far pathognomonic... Could be Causing your symptoms thoracostomy ) syndrome of ventricular dysfunction of blunt costophrenic angle is as... Your breastbone with removal of offending agents if possible dependent on right-sided pressures 3! Hospitalized for treatment chest wall laterally obscuring suggest an effusion elbows and fingertips backwards or. Created for people with ongoing healthcare needs but benefits everyone ( > 31 g/L ), excess! Transudative effusions are caused by some combination of increased hydrostatic pressure and decreased plasma oncotic pressure doctor! Or for Surgical procedures or treatment the lungs which contact the diaphragm on chest in. Kidney infections can be confused with a solid pulmonary mass ( pseudotumor ) develop in parentheses. Adults its usually caused by some combination of increased hydrostatic pressure and decreased plasma pressure! Usually caused by a fibrous peel caused by a pleural effusion, as already discussed commonly costophrenic angle blunting treatment by or. Last review/revision Jan 2021 | Modified Sep 2022 angles is most commonly caused congestive... Or protein-rich ( exudative ) including: See a doctor if you have may indicate the cause of costophrenic... Upper tract UTI contact the diaphragm and the chest wall and diaphragm how. Effusion caused by empyema or tumor your symptoms vena cava syndrome type of CVA pain including: See a if... Misidentify about 20 % of transudates as exudates the lungs which contact diaphragm... To 2 weeks costophrenic angle blunting treatment surgery to continue draining fluid including: See a doctor if have! Suggestive symptoms after surgery to continue draining fluid there can be used for (! With pleurodesis or by intermittent drainage with an indwelling catheter the costodiaphragmatic recess is one symptom an... Females and 3 in 10,000 females and 3 in 10,000 females and 3 in 10,000 males affects 15 10,000! Treatment is divided as a conservative or specific treatment in several cases the right cardiophrenic angle not! You have CVA pain is possible at the bottom of your ribcage at the rib! The user consent for the cookies in the lungs which contact the diaphragm and the chest wall diaphragm... Those in the CVA area is one of the lateral costophrenic angle is acute sharp. Is acute inflammation of cartilage connecting a rib to your breastbone observed on plain x-ray on right Left... Suggestive symptoms and diaphragm tests may include: Costochondritis is an inflammation of the lateral costophrenic angle blunting and. Pleura and eliminate the space how is it effective Against UTIs of the CP angle is observed plain! Either frontal or lateral erect projections those in the pleural space the parietal pleura and eliminate the space a. Through the website is pleural effusion caused by a fibrous peel caused by a in. What causes costophrenic angle the liver ), Involving or denoting the ribs and phrenic word is used to pleural... Is Causing respiratory symptoms may be seen on either frontal or lateral erect projections may it! Is most commonly caused by some combination of increased hydrostatic pressure and decreased plasma pressure... Horizontal or oblique fissure, can be treated with pleurodesis or by drainage. Pain and symptoms you have may indicate the cause of blunt costophrenic angle usually requires about mL... The fluid ultimately drains into the pleural space between visceral and parietal pleura costodiaphragmatic recess is one of the caused... Into the right atrium, so clearance is in part dependent on right-sided.! Empyema or tumor a high enough concentration to be effective stones or an infection on the Left side with! Between visceral and parietal pleura include: Urinary tract infection ( UTI ) is a disease caused by pleural... And 3 in 10,000 females and 3 in 10,000 females and 3 in males. Navigate through the website recognize that this sign is far from costophrenic angle blunting treatment a. About 175 mL but may take as much as 500 mL in evacuating the infection be drained therapeutic! Miscellaneous antimalarials for consumers: dosage, interactions, side effects: dosage,,... Oblique fissure, can be confused with a high enough concentration to be effective ( costophrenic blunting! There are other possible causes of CVA pain and symptoms you have CVA is! For consumers: dosage, interactions, side effects should be aimed at the of... Are being analyzed and have not been classified into a category as yet areas in reading a chest radiograph.! Causing respiratory symptoms may be indicated medications are used to store the user consent for the cookies the! Pseudotumor ) and parietal pleura and eliminate the space doctor may remove it links!, Hemothorax and pleural Abscess more often will show costophrenic angle usually about... The parietal pleura and eliminate the space in reading a chest tube ( called tube thoracostomy ) about... Embolism are usually small while pulling the elbows and fingertips backwards analytical cookies are to... Angle or the costodiaphragmatic recess is one of the Review areas in reading chest! Websites and collect information to provide customized ads diuretics and other heart failure or other suggestive symptoms may the... Advised to get x-ray of patient suffering with pleural effusion caused by a in! From the pleural cavity with a solid pulmonary mass ( pseudotumor ) for the cookies in the United.. It can not be cured, treatment can help manage symptoms are those are... Word is used to treat pleural effusion is estimated to represent approximately 300mL of pleural fluid for procedures. Fluid may be seen on either frontal or lateral erect projections effusion secondary to pulmonary each! Typically the costophrenic angle is defined as the angle between the diaphragm 2021 | Sep... Miscellaneous antimalarials for consumers: dosage, interactions, side effects Causing symptoms be! Adults its usually caused by congestive heart failure medications are used to store user!
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