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

Acrometastasis is an uncommon presentation of lung cancer with poor prognosis. We describe bone scintigraphy and FDG PET/CT findings in a case of pulmonary nuclear protein in testis (NUT) carcinoma with only initial presentation of bony metastasis to the distal phalanx of the right little finger after traumatic injury. FDG PET/CT showed intense activity of the primary lung tumor with multiple FDG-avid lymph node, adrenal, bone, and cartilage metastases including unusual and unexpected metastases at the finger, mandibular condyle, and thyroid cartilage. Bone scintigraphy significantly underestimated the extent of osseous involvement because the osseous metastases appeared as non-osteoblastic lesions.