Pseudotumor Case Study

Phantom or vanishing tumor stands for a localized transudativeinterlobar pleural fluid collection in congestive heart failure. Pseudotumors commonly manifest as incidental radiographic findings in patients with disorders associated with pleural effusions, especially congestive heart failure. The name originates from its frequent resemblance to a tumor on the chest X- ray and from its tendency to vanish after appropriate management of heart failure [1].

A pseudotumor may serve as a marker of left heart failure, or another disorder associated with transudative pleural effusions. A correctly diagnosed pseudotumor is typically an incidental finding that has minimal impact on patient management; however, pseudotumors may be erroneously diagnosed

He had shortness of breath increasing for the last two weeks. On review of symptoms, he denied cough and chest pain, but in last two days he had high temperature up to 38C. His medical history was significant for left ventricular failure with an ejection fraction of 30-35% measured by echocardiography. He undergone a bypass surgery 7 years ago, using ASA, ramipril, furosemide, spironolactone.He was a lifelong nonsmoker, using tiotropium bromide, fixed combination of inhaler corticosteroid/beta agonist and short acting beta agonist on

The chest examination was remarkable for dull auscultatorysound at the right side. The remainder of the physical examination was unremarkable. The blood pressure was 110/70mmHg and heart rate was 85 beats/min.The peripheral blood leukocyte count was 23000 x 109/L, with neutrophils 89%.C reactive protein was 276ng/l, while other parameters were in normal range. The posteroanterior chest radiogram showed pleural effusion on right side and imflammatory changes on rest right lung apically [Figure 1A]. He was admitted to the hospital and receive two antibiotics- ciprofloxacin and ceftriakson and his chronic cardiac therapy. We performed pleural punction and its analysis showed that pleural effusion is transudative etiology. We got 2 liters of serous fluid. After 3 days, we made control chest radiogram and laboratory findings [Figure 2A]. Chest radiogram showed significant improvement in lung parenchyma as well as reduction of pleural effusion. Laboratory finding were: Le 12,7x109/L, Neutophils 80% and C reactive protein was 123ng/l. The patient was feeling better. We have done echocardiography which showed enlargement in left heart chamber, systolic dysfunction, ejection fraction 25%, moderate mitral and aortic regurgitation, pulmonary artery pressure (42mmHg). The patient introduced intensive IV loop diuretic therapy. 48 hours later, a significant decrease in the pleurlaleffusion was observed [Figure