Case 218: Birt-Hogg-Dubé syndrome

History: A 53-year-old man presented to the emergency department with subacute poorly localized abdominal pain that was increasing in intensity. He had a history of spontaneous pneumothoraces and skin lesion biopsy. Clinical examination revealed numerous small dome-shaped flesh-colored papules on the head and neck, as well as multiple palpable soft pliable nontender subcutaneous tumors scattered over the chest, abdomen, and extremities. Laboratory test results were unremarkable. The patient underwent contrast material-enhanced multidetector computed tomography (CT) of the chest, abdomen, and pelvis after intravenous administration of 120 mL of iohexol (Omnipaque 350; GE Healthcare, Princeton, NJ) infused at a rate of 3 mL/sec.