PMC2249599_01
Chest X-ray: bilateral pleural effusions and extensive interstitial reticulo-nodular shadowing.
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F1
A repeat chest x-ray now showed bilateral pleural effusions and extensive reticulonodular shadowing [Figure 1].
Axial CT of the mid thorax with lung window settings: bilateral pleural effusions and diffuse septal thickening consistent with lymphangitis carcinomatosa.
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F2
Throughout both lungs there was extensive septal thickening typical of lymphangitis carcinomatosa as well as nodular areas suggestive of pulmonary metastases and moderate bilateral pleural effusions [Figure 2].
Axial CT through the mid-abdomen following intravenous contrast: the normal part of the right kidney(K) is seen posteriorly with a large mass containing central necrosis arising anteriorly(T). Enlarged lymph nodes(L) are also seen adjacent to the aorta.
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F3
Within the abdomen, a 9 x 13 cm mass containing central necrosis was present arising from the lower pole of the right kidney and associated with extensive retroperitoneal lymphadenopathy [Figure 3].