IS Case 224: Pseudotumor
Imaging Sciences URMC 2008
Publication Date: 2009-05-22
History
Patient is a 69-year-old male with dyspnea.
Diagnosis
Pseudotumor
Discussion
Pseudotumor on chest radiographs result from pleural effusions that subsequently loculate in the pleural fissures. They often occur with exudative pleural effusions, but can occur with transudative effusions as well. Common causes include hypoalbuminemia, renal insufficiency, and congestive heart failure (as in this case).
The pseudomass is usually lenticular in shape with sharp margins and usually less than 4 cm in size. Typically, collections in the minor fissure are well circumscribed on both the frontal and lateral views because the surface of the collection is parallel to the x-ray beam on both projections. Collections in the anterior, posterior, and lateral pleural spaces may appear well circumscribed in one projection and ill-defined in another based on the angle of projection with the fluid margin. Parenchymal masses will appear similar in different projections. Case reports of massive pseudotumors have been reported. Over 75% involve the minor fissure.
Misdiagnosis may result in unnecessary patient anxiety, antibiotics, invasive procedures such as biopsy, and other costly imaging tests. Management is conservative with treatment of the underlying condition.
References
- Webb WR, Higgins CB. Thoracic Imaging: Pulmonary and Cardiovascular Radiology. Lippincott Williams and Wilkins. Philadelphia, 2005.
- Haus BM, Stark P, Shofer SL, Kuschner WG. Massive pulmonary pseudotumor. Chest. 2003 Aug;124(2):758-60. [PMID: 12907571]
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