Phantom Tumor of the Lung: Localized Interlobar Effusion in Congestive Heart Failure

Abstract

Localized interlobar effusions in congestive heart failure (phantom or vanishing lung tumor/s) is/are uncommon but well known entities. An 83-year-old man presented with shortness of breath, swollen legs, and dry cough enduring five days. Chest-X-ray (CXR) revealed massive sharply demarked round/oval homogeneous dense shadow 10 × 7 cm in size in the right inferior lobe. The treatment with the loop diuretics and fluid intake reduction resulted in complete resolution of the observed round/oval tumor-like image on the control CXR three days later. Radiologic appearance of such a mass-like configuration in patients with congestive heart failure demands correction of the underlying heart condition before further diagnostic investigation is performed to avoid unnecessary, expensive, and possibly harmful diagnostic and treatment errors.

Pediatric phantom tumor caused by cardiac catheterization

“…Although phantom tumors (or vanishing tumors) of the lung caused by the loculation of pleural effusion in an interlobar fissure from exacerbated congestive heart failure are well described in adult cardiovascular medicine, they have never been reported in the pediatric field. Phantom tumors have been observed in the right side of the chest, which is likely due to the greater hydrostatic pressure, resulting in impaired venous and lymphatic drainage . In the present case, however, it is unclear whether congestive heart failure was caused by the invasive cardiac catheterization, a transient pulmonary embolization (with VSD and systemic pressure of the right ventricle), or both.…”

Tumor Appearance of the Lung in Heart Failure Patients

“…Phantom tumors should be considered in all patients presenting with congestive heart failure findings and having a lung mass appearance on chest X-ray. Considering the diagnosis of phantom tumor prevents unnecessary, expensive, and possibly harmful diagnostic and treatment errors [16,23].…”

“…Heart failure patients who have a history of pulmonary infection are more likely to develop phantom tumors during acute heart failure episodes [15,16]. Adhesive pleuritis was frequently detected in postmortem examinations in patients [17,18].…”

Lung mass in patient with congestive heart failure – Now you see it, now you don’t !

“…Exudative causes include parapneumonic pleural effusions, pleural empyema, malignant pleural effusion, haemothorax, and chylothorax. 1 As for this patient, he was initially referred for further investigations due to the suspicion of lung malignancy. A CT thorax was performed due to the presenting constitutional symptoms and the chest radiograph showed no resolution post diuresis.…”