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An 83-year-old man had a history of heart disease with repeated symptomatic episodes of congestive heart failure. He had most recently experienced progressive orthopnea and 3 weeks of paroxysmal nocturnal dyspnea. Due to the ineffectiveness of medical therapy, he was hospitalized. A posteroanterior chest radiograph showed a well-delineated, drop-like density that was possibly a tumor (Fig. 1). The patient was treated with furosemide, intravenous nitroglycerin, digoxin, and captopril. After 3 days, his condition gradually improved. When medical therapy had been completed 6 days later, a radiograph showed complete resolution of the opacity (Fig. 2).
Our patient's initial radiograph showed pleural fluid that had collected in a loculated region due to past episodes of pleuritis. This unusual condition has been called vanishing tumor, pseudotumor, or phantom tumor, because of its radiologic appearance as a mass-like configuration in the lung.1 Consequent to the small number of reported cases, the incidence of this entity is difficult to estimate.
Awareness of this form of pleural effusion is important in the differential diagnosis of a pulmonary mass on radiography. Effusions into the pleural cavity are frequent in cardiac failure, and they may reappear on radiographs during recurrent episodes of heart failure. Phantom tumors are commonly found within the transverse fissure, less frequently within the oblique fissure, and occasionally within both.1,2 A sharply demarcated density (usually in the right middle lung field, due to interlobar effusion) may be a malignant tumor of the lung.2 Our patient's drop-like phantom tumor in the right horizontal fissure, conversely, was related to congestive heart failure.
If radiographs show a pulmonary mass in patients with congestive heart failure, we suggest providing appropriate therapy with diuretics before further diagnostic investigation is performed.
Address for reprints: Idris Ardic, MD, Department of Cardiology, Erciyes University School of Medicine, 38039 Talas, Kayseri, Turkey