PMC6944973_01
CT abdomen and pelvis w/ contrast; arrow showing heterogenous density 2.5 x 3.5 cm lesion in vicinity of the right nephrectomy bed compressing the inferior vena cava.
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His RCC was staged as stage III (pT3N0M0) and graded as Fuhrman grade 3. He was lost to follow-up, and four years later, he was found to have a soft tissue mass at the nephrectomy surgical bed, indicating local cancer recurrence (Figure 1).
(a) CT chest w/ contrast. Arrow showing a 1.4 cm peripherally enhancing, partially speculated nodule in the left upper lung apex. (b) CT chest w/ contrast; ~18 months post discontinuation of nivolumab with the following findings: arrow showing a 0.4 cm enhancing nodule in the left upper lung lobe.
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This, along with multiple spiculated nodules in the right and left lung, is the largest being 1.4 cm (Figure 2(a)).
CT chest w/ contrast, lung window, showing initial acute pneumonitis findings: extensive ground-glass opacities and interlobular septal thickening with bilateral traction bronchiectasis. Pulmonary nodules are not well seen due to ground-glass opacities.
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CT chest showed confluent ground-glass and reticular opacities in bilateral lungs predominantly in the bases (Figure 3) concerning for pneumonitis from nivolumab therapy.
CT chest w/ contrast, lung window, showing lung findings post ~1.5 months of initial pneumonitis findings: significant improvement in scattered interstitial thickening and ground-glass opacities.
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A CT chest obtained 1.5 months after his hospital discharge showed significantly improved ground-glass opacities in both lungs, while his pulmonary nodules remained unchanged (Figure 4).
CT chest w/ contrast, lung window, showing lung findings post ~4 months of initial pneumonitis findings: mild emphysematous changes noted.
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He was monitored closely with CT chest, abdomen, and pelvis, and after four months (post pneumonitis admission), the ground-glass opacities have improved significantly (Figure 5), along with stable pulmonary nodules, and a stable nephrectomy site mass that remained unchanged on serial imaging.