Bone Scintigraphy and FDG PET/CT in a Case of Pulmonary NUT Carcinoma With Only Initial Presentation of Bony Metastasis to the Distal Phalanx of the Little Finger Following Traumatic Injury.
Zhengguang Xiao, Aisheng Dong, Fang Zhang et al.
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Case in brief
A patient with pulmonary NUT carcinoma presented with bony metastasis localized to the distal phalanx of the right little finger following a traumatic injury. Imaging with FDG PET/CT revealed intense activity in the primary lung tumor and multiple metastases, including unexpected sites such as the finger and thyroid cartilage. Bone scintigraphy, however, underestimated the extent of bone involvement due to the non-osteoblastic nature of the lesions.
What made this case unusual
The case highlights an atypical presentation of acrometastasis in lung cancer, specifically the initial manifestation in the distal phalanx of a finger, which is rare.
Diagnostic / clinical pearl
Clinicians should be aware that bone scintigraphy may underestimate osseous metastases in cases of non-osteoblastic lesions, as seen in this patient with pulmonary NUT carcinoma.
Why it matters
Understanding the limitations of bone scintigraphy in detecting certain types of metastases can guide more accurate imaging choices and improve patient management.