SHM Converge Scientific Abstract ePoster Gallery-Heart Failure Balls: An Imitator of Infectious Pulmonary Nodules

Pdf Summary

This case report highlights an uncommon cause of diffuse pulmonary nodules: heart failure. A 59-year-old man with chronic heart failure and sarcoidosis presented with shortness of breath during an acute heart failure exacerbation. Imaging, including serial PET/CT scans, showed new FDG-avid pulmonary nodules that initially raised concern for infection. Despite broad empiric antimicrobial and antifungal treatment, infectious testing remained negative. Bronchoalveolar lavage with biopsy ultimately revealed numerous hemosiderin-laden macrophages, known as “heart failure cells,” indicating pulmonary congestion rather than infection.<br /><br />The report explains that in heart failure, elevated pulmonary venous pressure can cause red blood cells to leak into the alveoli, where macrophages break down hemoglobin into hemosiderin. This process can create a nodular radiographic appearance sometimes termed “heart failure balls,” which may mimic infectious or malignant pulmonary nodules. The authors emphasize that cardiogenic pulmonary edema usually presents with classic findings such as interstitial edema, cardiomegaly, and pleural effusions, but can occasionally appear as diffuse nodules.<br /><br />The case illustrates the importance of including heart failure in the differential diagnosis of pulmonary nodules. A trial of diuresis may lead to resolution of the nodules and help clinicians avoid unnecessary biopsy, prolonged antimicrobial therapy, and associated complications. The authors conclude that recognizing this presentation can improve patient care and reduce avoidable costs and procedures.

Asset Subtitle

Kelly E. Moyer

Meta Tag

Author List David Cohen, Kelly E. Moyer

Category Clinical Vignettes

Concept Heart Failure

Concept Lung Nodule

Concept Pulmonary Congestion

Concept Hemosiderin-Laden Macrophage

Concept Heart Failure Cell

Distinguished Non-Finalist

Presenter Organization Sidney Kimmel Medical College

Presenting Author Kelly E. Moyer

Track Adult

Keywords

heart failure

pulmonary nodules

hemosiderin-laden macrophages

cardiogenic pulmonary edema

FDG-avid

PET/CT

bronchoalveolar lavage

pulmonary congestion

diffuse nodules

differential diagnosis

Heart Failure

Lung Nodule

Pulmonary Congestion

Hemosiderin-Laden Macrophage

Heart Failure Cell