Clinical History
A 90-year-old female patient fully independent regarding the basic activities of daily living (BADL) but with past medical history of hypertension and congestive heart failure (CHF) was referred to the radiology department for high suspicion of a pulmonary mass on a routine chest X-ray.
Imaging Findings
On the posteroanterior chest X-ray (Fig. 1a) projection two well-defined opacities are present on the right middle and lower pulmonary fields. The lateral view (Fig. 1b) reveals the pleural semiology of the greater opacity as well as its allineation with the major fissure. The second opacity is pictured on the periphery of the posterobasal segment of the right lower lobe.
A contrast-enhanced CT (Fig. 2) in the arterial phase is performed and revealed two collections with tomodensitometric values of serous fluid (5 Hounsfield Units) located within the major and superior accessory fissure.
Discussion
'Phantom' or 'vanishing' tumours are commonly secondary to a transudative pleural effusion within the fissures and are frequently associated with congestive heart failure (CHF). Sometimes, these findings can be misdiagnosed as malignancy leading to invasive unnecessary procedures to confirm the diagnosis.
It is important to remark that these opacities correspond to pleural effusion loculating within the fissures due to the higher hydrostatic pressure present in CHF [1]. The most common location is the minor fissure [2] but, as in this case, they can appear within the major fissure as well giving place to multiple mass-like opacities.
There is no specific treatment for such condition as long as effective fluid depletion with diuretics will mobilise the fluid forcing the opacities to disappear [3].
This case illustrates the condition particularly well, as 'phantom' tumours can be multiple and may appear wherever there is a fissure. Our patient had two 'phantom' tumours, one of them within a superior accessory fissure of the right lower lobe, and both disappeared after fluid depletion.
Written informed patient consent for publication has been obtained.
Differential Diagnosis List
'Phantom' or 'vanishing' tumours
Malignant tumour
Metastases
Atelectasis
Abscess
Final Diagnosis
'Phantom' or 'vanishing' tumours
