Biological activity of the fracture site is very important factor in treatment planning of fracture nonunion. If no biological activity is detected, then an autologous bone graft can be supplemented or osteogenic supplementations, such as bone morphogenetic protein is given. If biological activity is present, then secure fixation is sufficient to achieve bony union. Biological activity of nonunions is usually assessed by conventional radiographs. The presence of callus formation is usually assessed as the presence of biological activity. However, high number of radiologically nonhypertrophic nonunion demonstrates intense, uniform tracer uptake on bone scan, a sign of biological activity. Poor or absent callus visualization on radiographs does not always mean a lack of biological activity and it underestimates it. Uptake in bone scintigraphy reflects blood flow and new bone formation and being functional imaging technique, it is more suitable for assessing biological activity.

We report a case of a 56-year-old woman diagnosed with infiltrating ductal carcinoma of the left breast, who had undergone left modified radical mastectomy followed by radiotherapy and adjuvant chemotherapy. FDG PET-CT showed metastatic brachial plexopathy with intra-spinal and extra-axial brain metastasis. Metastatic brachial plexopathy along with brain and spinal metastasis is a rare condition with very less incidence. The scan also showed left para-sternal anterior chest wall recurrence with antero-superior mediastinal metastasis. 18FDG-PET scanning is a useful tool in evaluation of patients with suspected metastatic plexopathy. It may also be useful in distinguishing between radiation-induced and metastatic plexopathy. Typical pattern of FDG uptake and dual time point imaging may increase specificity and require further evaluation.

Hypercalcemia is a common life-threatening complication associated with several malignancies. Parathyroid-related peptide has been shown to cause hypercalcemia in several solid tumors but rarely in penile cancer. We report a case of penile cancer with hypercalcemia causing metastatic visceral calcification in lungs, liver, and stomach detected on bone scan without significant abnormalities on CT scan.