Rapidly vanishing lung pseudotumor in a patient with acute bilateral bronchopneumonia

Abstract

Introduction. Rapidly vanishing lung pseudotumor (phantom tumor) refers to the transient well-demarcated accumulation of pleural fluid in the interlobar pulmonary fissures. Most frequently their appearance is associated with congestive heart failure, but also other disorders like hypoalbuminemia, renal insufficiency or pleuritis. Its rapid disappearance in response to the treatment of the underlying disorder is a classical feature of this clinical entity. Case report. A 47-yearold woman, chronic smoker with symptoms of shortness of breath, orthopnea, chills, cough, weakness and the temperature of 39.2?C was admitted to our hospital. A posteroanterior chest X-ray revealed cardiomegaly with the cardiothoracic ratio of > 0.5, blunting of both costophrenic angles and an adjacent 6 x 5 cm well-defined, rounded opacity in the right interlobar fissure. Transthoracic 2-dimensional echocardiography demonstrated left ventricular hyperthrophy with a systolic ejection fraction of 25% and moderate mitral regurgitation. The patient?s symptoms resolved rapidly after diuresis, and repeated chest X-ray four days later showed that the right lung opacity and pleural effusions had vanished. Conclusion. The presented case underlines the importance of the possibility of vanishing lung tumor in patients with left ventricular failure and a sharp oval lung mass on the chest X-ray. This is the way to avoid incorrect interpretation of this finding causing additional, unnecessary, costly or invasive imaging, interventions and drugs.Uvod. Brzo nestajuci pseudotumor pluca (fantom tumor) predstavlja prolaznu, jasno ogranicenu kolekciju pleuralne tecnosti u interlobarnim pulmonalnim fisurama. Najcesci uzrok njihovog nastanka je zastojna srcana slabost, ali, takodje, i drugi poremecaji kao sto su hipoalbuminemija, bubrezna insuficijencija i pleuritis. Tipicna karakteristika ovog klinickog entiteta je njegovo brzo nestajanje pri lecenju osnovnog, uzrocnog oboljenja. Prikaz bolesnika. Bolesnica, stara 47 godina, hronicni pusac, primljena je u nasu bolnicu zbog simptoma gusenja, ortopneje, jeze i drhtavice, kaslja, opste slabosti i povisene telesne temperature od 39.2?C. Radiografija pluca i srca u posteroanteriornoj projekciji je pokazala postojanje kardiomegalije sa kardiotorakalnim indeksom > 0,5, zasencenje oba kostofrenicna sinusa i dobro ogranicenu, kruznu infiltraciju velicine 6 x 5 cm u predelu desne interlobarne fissure. Dvodimenzionalni transtorakalni ehokardiogram je pokazao postojanje hipertrofije leve komore sa sistolnom ejekcionom frakcijom od 25% i umerenom mitralnom regurgitacijom. Vrlo brzo nakon zapocinjanja diuretske terapije simptomi su se povukli i cetvrtog dana hospitalizacije pri ponovljenoj radiografiji pluca doslo je do kompletnog povlacenja pleuralnih izliva kao i znakova zasencenja na plucima. Zakljucak. Prikaz nase bolesnice naglasava znacaj razmatranja mogucnosti nestajuceg pseudotumora pluca kod bolesnika sa levostranom srcanom slaboscu i ostro ogranicenom ovalnom masom na radiografiji pluca. Na ovaj nacin moze se izbeci pogresna interpretacija radiografskog nalaza i dalje nepotrebno izlaganje bolesnika dodatnim, skupim i invazivnim ispitivanjima, intervencijama i lekovima.