Inflation of narrow tube-fed basaltic lava flows (tens of meters across), such as those confined by topography, can be focused predominantly along the roof of a lava tube. This can lead to the development of an unusually long tumulus, its shape matching the sinuosity of the underlying lava tube. Such a situation occurred during Kīlauea Volcano's (Hawai'i, USA) ongoing East Rift Zone eruption on a lava tube active from July through November 2010. Short-lived breakouts from the tube buried the flanks of the sinuous, ridge-like tumulus, while the tumulus crest, its surface composed of lava formed very early in the flow's emplacement history, remained poised above the surrounding younger flows. At least several of these breakouts resulted in irrecoverable uplift of the tube roof. Confined sections of the prehistoric Carrizozo and McCartys flows (New Mexico, USA) display similar sinuous, ridge-like features with comparable surface age relationships. We contend that these distinct features formed in a fashion equivalent to that of the sinuous tumulus that formed at Kīlauea in 2010. Moreover, these sinuous tumuli may be analogs for some sinuous ridges evident in orbital images of the Tharsis volcanic province on Mars. The short-lived breakouts from the sinuous tumulus at Kīlauea were caused by surges in discharge through the lava tube, in response to cycles of deflation and inflation (DI events) at Kīlauea's summit. The correlation between DI events and subsequent breakouts aided in lava flow forecasting. Breakouts from the sinuous tumulus advanced repeatedly toward the sparsely populated Kalapana Gardens subdivision, destroying two homes and threatening others. Hazard assessments, including flow occurrence and advance forecasts, were relayed regularly to the Hawai'i County Civil Defense to aid their lava flow hazard mitigation efforts while this lava tube was active.