Fissural pleural effusion mimicking a lung mass: a diagnostic pitfall in the Emergency Department

Abstract Background Phantom tumour, also known as a vanishing tumour or fissural pseudotumor, is an uncommon condition that represents a localized, transudative, loculated interlobar pleural effusion. It occurs predominantly in patients with heart failure or renal dysfunction and may mimic a pulmonary neoplasm on chest radiography. Rapid resolution following diuretic therapy is characteristic and typically occurs in the setting of acute decompensated heart failure. Case presentation We report the case of a 79-year-old male with a known history of ischemic heart disease who presented to the Emergency Department with acute dyspnea and orthopnea. Chest radiography demonstrated a well-circumscribed opacity in the right lung, which was initially suspicious for malignancy. The patient responded well to diuretic therapy for the fluid overload, with near-complete symptomatic improvement and complete radiographic resolution—findings that are characteristic of and confirm the diagnosis of a phantom tumour. Conclusions Early recognition of phantom tumour is crucial, as misinterpretation may lead to unnecessary investigations, including contrast-enhanced computed tomography of the chest. This is particularly important because many affected patients have underlying chronic kidney disease, and exposure to iodinated contrast may worsen renal function and, in some cases, precipitate the need for renal replacement therapy. Raising awareness of this uncommon yet clinically meaningful condition among emergency physicians and radiologists is essential for optimizing patient outcomes and avoiding preventable harm.