Archived case 250 · December 5-December 12, 2019
The chest radiograph demonstrates a left retrocardiac 4 cm mass-like opacity
History: 33 y.o. male. Heart failure.
The question posed to readers
Evaluate for pacemaker placement
Images
Imaging findings
This case illustrates two signs in chest imaging: a pseudomass sign and a flat waist sign. Both are caused by left lower lobe collapse. The flat waist sign is flattening of the left heart border and downward displacement of the left hilum. A pseudomass is an appearance of an underlying lesion that is not real, and is due to other factors, in this case, left lower lobe collapse. A cardiac MRI (axial VIBE attached) was performed within 10 days of this chest radiograph, and shows no retrocardiac mass, only left lower lobe atelectasis and a trace left effusion. Answer Diagnosis: The chest radiograph demonstrates a left retrocardiac 4 cm mass-like opacity.
Diagnosis
The chest radiograph demonstrates a left retrocardiac 4 cm mass-like opacity
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(Click for a larger image.)
Original case written by its authors at Virginia Commonwealth University and published at this address as part of a weekly teaching collection. Reproduced here as an archive.