The patient is a 65-year-old man who was disoriented while on admission for pleural effusion. Pleural biopsy was positive for tuberculosis, but because fluid cytology suggested possible adenocarcinoma, a whole body bone scan was requested and showed bilateral flame-shaped foci in the distribution of the middle cerebral arteries. A repeat bone scan done 6 weeks later because of a traumatic fracture showed both the new fracture site and resolution of the cerebral foci.
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