The patient is an 60 64 year old white male who presented with a remote history of an abdominal melanoma that was excised with negative margins. The patient has been experiencing lower left sided back pain for the past several months and has received epidural injections. As Imaging showed a part of the workup, the patient had left perinephric retroperitoneal hematoma and a CT which revealed retroperitoneal lymphadenopathyleft renal lower pole cystic lesion with hemorrhage. Additional imaging showed numerous pulmonary lesions. A CT endobronchial ultrasound guided fine needle aspiration and biopsy of a paracaval lymph node was performedscheduled.

* 2003 MelanomaCongestive heart failure* DiabetesVentricular tachycardia* HypertensionIschemic heart disease

* 2013 Arthroscopic knee surgeryCoronary stent placement* 2003 Excision Implant of melanoma* 2002 DiscectomyAICD

The differential diagnosis for otherwise asymptomatic lymphadenopathy in this patient concern is melanoma, lymphoma, or occult a primary renal malignancywith metastatic disease to lungs. An endobronchial ultrasound guided FNA is scheduled.

* PET CT showed hypermetabolic activity with an SUV of 12.7Abdomen shows a large perinephric hematoma and large low anterior structure in left lower pole suspicious for a hemorrhagic renal cell carcinoma. * CT of abdomen and pelvis showed adenopathy adjacent Chest shows multiple small lung lesions measuring up to the aorta and inferior to the vena cava at the level of the right kidney. The largest node measured 4 cm 13x12 mm in greatest dimension.  

This is a classic case of Hodgkin lymphomametastatic renal cell carcinoma.