Monday, May 1, 2017

Pseudotumor Of The Lung On Chest X ray

X ray chest of a 48 year old woman who presented with generalized weakness is shown below:

Description: Chest X-ray shows an oval soft tissue density which overlays over most of the minor fissure. It is well-defined, no calcification seen and the surrounding lung is clear.

Diagnosed as Pseudotumor.

Comments And Explanation: Loculation within the fissure gives appearance of a tumor and is referred as pseudotumor. The pulmonary pseudotumor is sharply marginated collection of pleural fluid contained either within an interlobar pulmonary fissure or in a subpleural location adjacent to a fissure. Pseudotumors are identified on chest X-rays on their lenticular pattern.
CT chest confirms a loculated effusion within the fissure with Hounsfield value that of a transudate. The pseudotumor resolves with conservative management.
Most occur in the minor (horizontal) fissure and are seen on both the frontal and lateral radiograph; those that occur in the oblique or major fissure may only be seen on the lateral view. Pseudotumors may be erroneously diagnosed as parenchymal lung nodules or masses.

Clinical Discussion: Pseudotumor or vanishing tumor of the lung is an appropriate designation for a
localized transudative interlobar pleural fluid collection. It derives its name from its frequent resemblance to a tumor on X-ray chest and from its tendency to vanish following appropriate management.

Encapsulation is due to adhesions between contiguous pleural surfaces. Therefore, it is often seen after episodes of pleuritis. The pleural encapsulation can be mistaken for pulmonary consolidation, collapse, or a mediastinal tumor. The borders of a loculated effusion are convex unlike pulmonary collapse or consolidation. There may be pleural thickening elsewhere in the thorax. It is most commonly seen in the minor fissure.
The possibility of a vanishing lung tumor should be considered and excluded in any patient presenting with congestive heart failure or apparent lung mass on a chest X-ray.

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