What’s causing this patient’s lung mass?

January 09, 2019

Figure 1 Quiz of the Week

A 60-year-old man presents to the emergency department with worsening shortness of breath and a non-productive cough. He has congestive heart failure and was treated three weeks earlier at a neighboring hospital. On examination, he has normal vital signs and marked bilateral pitting lower limb edema. A chest X-ray demonstrates the opacity seen here. A consultant recommends administering diuretics and repeating the chest X-ray in the morning.

What changes would you expect to see in the opacity on repeat X-ray?

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Image credit: @AlAshqarA

Answer: Disappearance

This patient’s findings are suggestive of a phantom (or vanishing) tumor of the lung. These pseudotumors are caused when fluid accumulates within an interlobar fissure secondary to congestive heart failure. The opacity will resolve with management of the underlying heart condition, and no other direct treatment is required. Recognition of this uncommon occurrence can help avoid unnecessary lung biopsies or antibiotic therapy.

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