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Table of Contents
- The ghost tumor, also called ” Vanishing tumor Lung, is caused by an accumulation of liquid in the pleural space in the event of pulmonary congestion.
- On thoracic radiography, nodular shadows, sometimes multiple, are often misinterpreted as a malignant tumor or metastases.
- It is associated with chronic heart or renal failure and disappears by single administration of diuretics, but it can recur in the event of decompensation of the underlying disease.
Patient and history
A 79-year-old ex-smoker, with heart failure known following ischemic cardiomyopathy and chronic renal failure due to a renal artery stenosis, has presented In the emergency room of the Viana Do Castelo hospital in Portugal with shortness of breath, orthopnee and nightship dyspnea for 2 days.
Results
Vital parameters:
- Blood pressure 170/95 mmHg
- Pouls 110 bpm, SpO2 88 %
Clinical examination:
- Anxious patient
- Light labial cyanosis
- Moderate dyspnea
- Orthopneous
- Use of respiratory auxiliary muscles
- Congestion of the visible jugular vein
- Bilateral basal frizzy
- Bilateral peripheral edema of the leg extending to the middle of the calf
Thoracic x -ray:
- Nodular shadow on the right side
Treatment
The patient’s history suggested a malignant tumor of the lung, but due to its acute symptoms of pulmonary edema, diuretic treatment with furosemide was first established. In the space of 24 hours, its symptoms have improved significantly and, with monitoring radiography, the nodular shadow had disappeared.
Discussion
The ghost tumor of the lung is rare, but clinically important, because it can be confused with neoplasia because of its radiological presentation.
This well -defined homogeneous mass results from an accumulation of liquid in the transverse, transversal pleural space. In 3 -quarters of cases, this phenomenon is consecutive to pulmonary congestion which occurs in a not necessarily serious context, heart or renal insufficiency, hypoalbuminemia or pleurisy. It affects elderly men more often. This atypical distribution of pleural effusion is due to adhesions and a terminal obliteration of pleural space within the framework of pleurisy.
Thus, ghost tumors appear when the pulmonary transudat goes beyond the lymphatic resorption capacity. Another mechanism would be due to elastic recall forces locally reinforced by adjacent attelectasies which, by their aspiration effect, would promote localized accumulation of liquid.
The differential diagnostics of these radiological results are: pulmonary infarction, pneumonia, tuberculosis, attelectasis, malignant space tumor, metastasis, abscess, emphyseme, cyst and arteriovenous aneurysm. Localized pleural effusions must be distinguished from transudats linked to renal failure, parapneumonic exudates, clever or benign associated with asbestos, as well as hematothorax, chylothorax and fibrous tumors of the visceral pleura.
On the other hand, a pulmonary pseudotummer is due to leftovers of organized focal pneumonia or lymphoma precursors; Histologically, many variants of xanthome, histiocytoma, mastocytic or plasma cells are possible.
The diagnosis is difficult and the best way to achieve this is to demonstrate the disappearance of symptoms after the administration of diuretics. However, atypical pleurural effusions are also well represented on the lateral radiography of the chest, transthoracic echocardiography or pulmonary ultrasound. Thoracic CT can also be useful to define the nature of the liquid and to exclude any pathologies.
Clinicians and radiologists must take into account this unusual differential diagnosis and be able to diagnose it quickly in order to avoid unnecessary invasive examinations as well as increased stress for the person concerned. Critical lighting of the compilation of the results of anamnesis, clinical examination and imaging is important.
Conservative diuretic treatment results in rapid, generally complete improvement.
This article has been translated fromUnivadis.de. The content was reviewed by the editorial staff before publication.
