Fig. 7. Axial contrast enhanced CT on soft tissue (A, B) and lung windows (C) in 38-year-old man lifelong non smoker with metastatic ALK rearranged lung adenocarcinoma.

A, B. Initial CT demonstrates extensive left pleural nodularity and circumferential thickening with example of pleural thickening in left lower lobe included (arrows). C. Follow up performed 8 weeks after treatment with alectinib (second generation ALK inhibitor) demonstrated decrease in left pleural metastatic disease but interval development of new right lower lobe ground glass changes (arrowheads) consistent with pneumonitis. Patient was not symptomatic and therapy was continued. ALK = anaplastic lymphoma kinase