An 85 year old female patient with known locally advanced adenocarcinoma of the lung of mucinous sub-type sustains a traumatic proximal femoral fracture following a low energy fall and undergoes hip hemiarthroplasty. Her past medical history included a previous left deep vein thrombosis and hypertension. She is further investigated with an isotope study for metastatic disease 24 hours after surgery (Figs. 1, 2 and 3).

Fig. 1
figure 1

Technetium-99 m hydroxymethylene diphosphonate (HMDP) 2 h whole body scintigraphy

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Fig. 2
figure 2

a Pelvic radiograph; b right hip radiograph

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Fig. 3
figure 3

Axial CT scan with bone [C:500 W:2500] and soft tissue [C:70 W:500] windowing of the (a, b) proximal and (c, d) distal lower limb

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