This case is described in part in the paragraph of lung carcinoma (chapter 16): Àngel González-Sistal, Alicia Baltasar Sánchez, Michel Herranz Carnero and Álvaro Ruibal Morell (2011). Advances in Medical Imaging Applied to Bone Metastases, Medical Imaging, Dr. Okechukwu Felix Erondu (Ed.), ISBN: 978-953-307-774-1. http://dx.doi.org/10.5772/28519 - http://hdl.handle.net/2445/21498

We present a 53-year-old man with a vocal cord paralysis observed as a primary manifestation of lung carcinoma. Tc-99m MDP whole body bone scan were performed and resulted a normal scintiscan. The bone scan does not revealed suspicious foci of uptake. The possibility of bone metastasis was taken into consideration. A whole body F18-FDG-PET scan showed intense uptake in the left upper lung corresponding to the primary tumor. A bronchial biopsy confirmed infiltration by small cell lung carcinoma (SCLC). SCLC is composed of poorly differentiated, rapidly growing cells with disease usually occurring centrally rather than peripherally. It metastasizes early. The whole-body F18-FDG-PET scan clearly demonstrated a focus of increased uptake in the second lumbar vertebral body suspicious for osteolytic metastasis. A lytic bone metastasis was confirmed by MRI. The patient then received therapy and underwent follow up abdominal CT. The scan showed blastic changes in the L2 vertebra suggesting response to treatment.