Chest tube placement for parapneumonic effusion was followed by the development of a persistent cardiophrenic angle mass with chronic granulomatous inflammation and eosinophilia.
Case Report (n=1)
This case highlights the need to consider post-procedural inflammatory etiologies, such as hypersensitivity or hematoma organization, in patients presenting with atypical cardiophrenic angle masses after chest tube placement.
Abstract Introduction Mass lesions in the cardiophrenic angle are uncommon and can arise from diverse etiologies including pericardial cysts, lymphadenopathy, neoplasms, or inflammatory processes. Such lesions developing after chest tube placement are rare. This case highlights a persistent cardiophrenic angle mass with associated eosinophilia in a patient previously treated for parapneumonic effusion. Description A 28-year-old male with a recent history of community-acquired pneumonia complicated by parapneumonic effusion, status post thoracentesis and left pigtail insertion, presented four months after discharge with chest pain but no infectious symptoms. Acute coronary syndrome was excluded, with normal troponin levels and an unremarkable EKG. Laboratory evaluation revealed eosinophilia (10%), while the remainder of the blood work was unremarkable. Chest X-ray demonstrated a vague opacity in the left lower lung base. Subsequent CT of the chest revealed a soft tissue lesion in the left cardiophrenic angle exerting mass effect on the adjacent heart. MRI confirmed a 6.7 × 3.4 × 4.6 cm lesion, interpreted as most likely a hematoma. Four months prior, during his hospitalization for pneumonia, it had been noted that the patient had close contact with a tuberculosis (TB) patient. Consequently, pleural samples and bronchoscopy with transbronchial biopsy were obtained to rule out TB, all of which returned negative. During the current admission, a CT-guided biopsy of the cardiophrenic lesion was performed. Histopathology demonstrated marked chronic inflammation with granulomatous reaction and was negative for fungi, TB, and neoplasm. The patient was discharged with plans for follow-up imaging. Two months later, repeat MRI showed a slightly increased lesion measuring 7.1 × 3.1 × 4.8 cm. The lesion demonstrated increased T2 signal with surrounding edema, restricted diffusion, increased T1 signal, and mild enhancement, consistent with a chronic inflammatory process. Autoimmune panels were sent and returned negative. The patient remained asymptomatic and was advised to continue follow-up with pulmonology for further evaluation. Discussion The development of a persistent soft tissue lesion in the cardiophrenic angle following pneumonia and chest tube placement raises several diagnostic considerations. The imaging findings and chronic inflammatory histopathology excluded neoplastic, tuberculous, and fungal etiologies. Eosinophilia in this setting may reflect an underlying hypersensitivity or inflammatory response, possibly triggered by prior pleural injury, hematoma organization, or eosinophilic infiltration as seen in chronic eosinophilic pneumonia. A localized eosinophilic reaction or sequela of prior chest tube insertion may explain the findings, emphasizing the need to consider post-procedural inflammatory etiologies in atypical cardiophrenic angle masses. This abstract is funded by: None
Garcia et al. (Fri,) conducted a case report in Persistent cardiophrenic angle mass (n=1). Chest tube placement was evaluated. Chest tube placement for parapneumonic effusion was followed by the development of a persistent cardiophrenic angle mass with chronic granulomatous inflammation and eosinophilia.