Aggressive diuresis in a patient with decompensated heart failure led to near-complete resolution of a suspected 4 cm right-upper-lobe mass, revealing it to be fissural fluid.
Case Report (n=1)
In patients with heart failure, fissural or pleural fluid can closely mimic malignancy on CT, and aggressive diuresis can resolve these pseudomasses, preventing unnecessary procedures.
Abstract Background Pulmonary masses frequently trigger urgent oncologic evaluation, yet cardiac or posttraumatic processes can occasionally create masslike opacities on imaging. Recognizing these mimics is crucial to prevent unnecessary procedures and delays in care. Case Presentation A 61yearold man with remote tracheostomy after a motor vehicle accident presented for coronary artery bypass graft (CABG) evaluation after several months of cough, exertional dyspnea, fatigue, and lightheadedness. At an outside hospital, he was found to have ischemic cardiomyopathy (EF 15-20 %), acute kidney injury, elevated troponin (peak 409 ng/L), and BNP 10,000 pg/mL. Chest CT revealed a 4 cm rightupperlobe (RUL) mass and a 6 mm leftupperlobe nodule, prompting pulmonary consultation and scheduling for bronchoscopy.The patient underwent aggressive diuresis for decompensated heart failure, with marked clinical improvement. When our weekday pulmonary team assumed care, the imaging was reevaluated with thoracic radiology. The RUL lesion demonstrated fissural fluid tracking and dependent changes rather than a solid mass, consistent with postdiuretic fluid redistribution and prior traumatic scarring. Repeat CT confirmed nearcomplete resolution. Bronchoscopy was cancelled, and the patient proceeded to CABG without delay or complication. Discussion This case underscores the importance of multidisciplinary image review and clinical correlation in distinguishing true pulmonary masses from pseudomasses. In patients with heart failure, fissural or pleural fluid can closely mimic malignancy on CT. Conclusion Careful collaboration between pulmonology, radiology, and cardiology prevented an unnecessary bronchoscopy and allowed timely revascularization. Not all “masses” are malignant—sometimes, they simply need a good diuresis. This abstract is funded by: none
Noureldin et al. (Fri,) conducted a case report in Ischemic cardiomyopathy with decompensated heart failure (n=1). Aggressive diuresis was evaluated. Aggressive diuresis in a patient with decompensated heart failure led to near-complete resolution of a suspected 4 cm right-upper-lobe mass, revealing it to be fissural fluid.