Thoracic manifestations of renal cell carcinoma

Over 1/3 of patients with renal cell carcinoma will present with metastases with no symptoms referable to the kidney. Early metastatic disease is a result of the unique accessibility of the kidney to lymphohematogenous pathways. The thorax is particularly vulnerable. Several of the more unusual manifestations involving the thorax are illustrated, including 1 case with intra-alveolar metastases.