Multiple left-sided vanishing tumors.

A 57-year-old man with hemodialysis-dependent end-stage renal disease presented with left upper quadrant abdominal pain, chills, and vomiting. He also noted a nonproductive cough of several days’ duration but reported no chest pain, dyspnea, fever, or hemoptysis. His history was remarkable for a gunshot wound to the left chest requiring a thoracotomy 20 years prior. He also had hypertension and type II diabetes, and he had been treated with 6 months of isoniazid therapy for a positive purified protein derivative 20 years prior. There was a 60 pack-year smoking history, but no alcohol or illicit drug use. A chest radiograph obtained during evaluation demonstrated two lung masses, which prompted hospital admission (Fig 1). Physical examination disclosed a comfortable man who was afebrile. The chest revealed a well-healed left thoracotomy scar and bilateral inspiratory crackles. The cardiovascular examination demonstrated a 3/6 apical systolic murmur and bilateral 21 pitting pedal edema. An arteriovenous fistula of the left arm had a palpable thrill. Laboratory studies were remarkable for a normal leukocyte count, a hemoglobin level of 10 g/dL, and a serum creatinine level of 5.3 mg/dL. An echocardiogram obtained after admission demonstrated left ventricular hypertrophy, mild systolic dysfunction, and moderate mitral regurgitation; there was no pericardial effusion. A CT scan of the chest was performed (Fig 2).