Images in an 81-year-old man who presented with cough and back pain. The
patient was a former smoker. (A, B) Fluorodeoxyglucose
(FDG) PET/CT scans demonstrate a left hilar mass (arrow in
A) with mediastinal and left hilar lymphadenopathy
(arrow in B) and bone metastasis, representing extensive
stage small cell lung cancer. (C, D) Bone metastasis in the
left iliac bone is better seen on PET/CT scan (C) as
intense focal FDG uptake (circle in C) without definitive
correlate on CT scan (D) (circle in D).
(E) Chest CT scan at diagnosis also demonstrates severe
centrilobular emphysema with mild peribronchial thickening in the
underlying lungs in this former smoker. The patient received several
lines of systemic therapy, including carboplatin and etoposide,
irinotecan, and nivolumab; however, disease progressed and the patient
died 10 months after the diagnosis.