Multiple pulmonary nodules in an asymptomatic patient.

A 49-year-old black woman presented after an initial radiologic evaluation of her shoulder incidentally revealed the presence of multiple pulmonary nodules. The asymptomatic patient denied dyspnea, cough, sputum production, hemoptysis, or fever. There was no history of malignancy. Her history included only a hysterectomy and left-sided oophorectomy performed approximately 12 years earlier for uterine fibroids. A chest roentgenogram revealed multiple pulmonary nodules scattered throughout both lung fields (Fig 1). CT of the chest (Fig 2) demonstrated innumerable, moderately well-circumscribed nodules ranging in size from a few millimeters to 2 cm. A pericardial effusion was also identified (Fig 3). Pulmonary function test results were relatively unremarkable, and an echocardiogram confirmed the presence of a small pericardial effusion with normal left ventricular function. A percutaneous biopsy was performed. What is the diagnosis?