Absent sternum as the first manifestation of bone metastasis on bone scintigraphy

The sternum is known as a relatively common site for bone metastases by a variety of malignant neoplasms. The usual finding is increased radiotracer uptake on bone scintigraphy, and cold metastasis is distinctly unusual. In addition, total nonvisualization of the sternum presenting as bone metastasis is extremely rare. We describe two cases with similar findings (absent sternum showing no activity of the sternal segments on bone scintigraphy), which corresponded to metastatic involvement. These findings were shown to be the first manifestation of hepatocellular carcinoma in one patient and bone metastasis in another patient with ovarian cancer.