A 3-year-old girl with stage III diffuse anaplastic Wilms tumor who has undergone nephrectomy, 6 weeks of chemotherapy, and whole abdomen/right hemithorax/flank irradiation develops new pulmonary nodules in the right upper lobe that are revealed on routine surveillance chest computed tomography (CT) scan (Figure). The girl is asymptomatic; she has no fever, cough, wheeze, hypoxemia, chest pain, or tachypnea. The most significant concern is progressive disease with new pulmonary metastases. A positron emission tomography scan with a chest CT scan 1 week later documents resolution of the initial nodules and development of multiple new ill-defined nodules throughout all lobes (Figure). Further clinical history obtained from the patient reveals a long history of pica and playing in the neighborhood sandbox. Laboratory values document hypereosinophilia and hypergammaglobulinemia. Imaging obtained 4 weeks later again identifies resolution of old nodules and evidence of new nodules (Figure). The migratory pattern of...

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