The Appearance of a Secondary Bone Lesion in Place of Nonspecific Vertebral Anomalies Related to Mediastinal Venous Thrombosis: Coincidence?

A 66-year-old woman with locally advanced lung adenocarcinoma underwent FDG-PET/CT, which revealed superior vena cava invasion and thrombosis of the brachiocephalic veins. Tracer injection on the side of thrombosis demonstrated hypermetabolism in the dorsal spine, likely due to collateral venous drainage. Following chemoradiotherapy and early discontinuation of immunotherapy for toxicity, she developed cervicobrachial neuralgia 18 months later. MRI showed marrow replacement lesions and FDG-PET/CT identified bone recurrence at D1, correlating with previously nonspecific fixation abnormalities. This case raises the question of whether vertebral venous stasis may favor metastatic grafting and highlights the potential need for contralateral FDG injection.