Volume 135, Issue 4, Pages 1102-1106 (April 2009) Cardiac Tumor and Renal Involvement in a Nonsmoker With Centrilobular Pulmonary Nodules  Huck Chin Chew, MBBS, MMed, Cheah Hooi Ken Lee, MBBS, Foong Koong Cheah, MBBS, Soon Thye Lim, MBBS, Chian Min Loo, MBBS, FCCP  CHEST  Volume 135, Issue 4, Pages 1102-1106 (April 2009) DOI: 10.1378/chest.08-0532 Copyright © 2009 The American College of Chest Physicians Terms and Conditions

Figure 1 Contrast-enhanced CT scan of sagittal view of kidneys in the nephrogenic phase showing bilateral symmetrical infiltration of the perirenal space (black arrows) encasing both kidneys, giving rise to a “hairy kidney” appearance. CHEST 2009 135, 1102-1106DOI: (10.1378/chest.08-0532) Copyright © 2009 The American College of Chest Physicians Terms and Conditions

Figure 2 T2-weighted MRI of the heart using the half-Fourier, single-shot, spin-echo technique showing an isointense right wall thickening and lumen distortion, giving an atrial pseudomass appearance (white arrow) in addition to a pericardial effusion (black arrow). CHEST 2009 135, 1102-1106DOI: (10.1378/chest.08-0532) Copyright © 2009 The American College of Chest Physicians Terms and Conditions

Figure 3 Contrast-enhanced CT scans of the thorax in the (top) lung and (bottom) soft-tissue windows, revealing multiple centrilobular nodules (curved arrows) in both lungs with septal (straight black arrows) and fissural thickening (straight white arrows), as well as diffuse patchy ground-glass changes. There was also mural circumferential thickening of the aorta (narrow black arrow on both scans), commonly referred to as coated aorta. CHEST 2009 135, 1102-1106DOI: (10.1378/chest.08-0532) Copyright © 2009 The American College of Chest Physicians Terms and Conditions

Figure 4 Postconstrast T1-weighted MRI of the brain in the coronal plane showing a large irregular and heterogeneously enhanced mass (arrow) at the foramen magnum, causing compression of the fourth ventricle with obstructive hydrocephalus. CHEST 2009 135, 1102-1106DOI: (10.1378/chest.08-0532) Copyright © 2009 The American College of Chest Physicians Terms and Conditions

Figure 5 Biopsy specimen from canthal xanthogranulomas showing touton-type multinucleated giant cells (black arrow). There was proliferation of large histiocytes with round-to-oval nuclei and moderate-to-abundant cytoplasm and surrounding fibrosis. Accompanying the histiocytic proliferation was infiltration of small lymphocytes and plasma cells (Diff-Quick stain [Siemens Healthcare Diagnostics; Deerfield, IL]; original ×600). CHEST 2009 135, 1102-1106DOI: (10.1378/chest.08-0532) Copyright © 2009 The American College of Chest Physicians Terms and Conditions

Figure 6 Biopsy of the perinephric mass showing infiltration of foamy lipid-laden histiocytes with round-to-oval nuclei and eosinophilic cytoplasm. Accompanying the histiocytic proliferation was variable infiltration of small lymphocytes and plasma cells (Papanicolaou stain, original ×600). CHEST 2009 135, 1102-1106DOI: (10.1378/chest.08-0532) Copyright © 2009 The American College of Chest Physicians Terms and Conditions