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Phantom tumour, vanishing tumour, and pseudotumour of the lung are terms used to describe the tumour appearance on a chest radiograph of a decompensated heart failure patient, which typically disappears after appropriate treatment of their underlying condition. It is a loculated pleural effusion in the fissures that gives rise to the tumour appearance on the chest radiograph of a patient with heart failure. Its existence might mislead the diagnosis, resulting in unnecessary invasive diagnostic investigations done on the patient. We present a case of a 64 year-old male with multiple co-morbidities presenting with dyspnea, loss of weight, and loss of appetite. A chest radiograph showed homogenous opacity over the right lower zone with cardiomegaly, raising the suspicion of a lung mass apart from heart failure. It disappeared after appropriate diuretic treatment. The computed tomography (CT) thorax, which was planned by the primary team, subsequently showed no lung mass. Hence, a high index of suspicion of phantom tumour is important when a lung mass is noted on a chest radiograph of a patient clinically presented with heart failure. This is because exposure to ionising radiation from CT is completely avoidable with just appropriate treatment of fluid overload. However, CT is still the best modality for assisting physicians in a doubtful case.

Osimertinib is a third-generation thyroxine kinase inhibitor (TKI) used in treating advanced non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) mutation. Osimertinib is used as a second line treatment for patients who develop EGFR T790 M resistance mutation rather than first line due to financial constraints. We present a case of a 60-year-old Chinese gentleman who diagnosed as stage 4 adenocarcinoma with EGFR Exon 19 deletion. His disease progressed after a year of treatment with afatinib. His plasma T790 M was negative and due to delay in tissue biopsy, he was empirically started on osimertinib. However, in view of financial concerns, he opted a dose reduction of 80 mg every alternate day rather than the conventional dose of 80 mg daily. Serial CT Thorax showed partial response based on RECIST 1.1 criteria and he has 9 months of progression free survival. This case report shows that Osimertinib in reduced dose may achieve good partial response and progression free survival in patients.