Delayed diagnosis of lung cancer after missed vertebral metastasis on CT

A 71-year-old man presented with a 4-month history of severe atraumatic monolateral hip pain. Radiographs were normal, and MRI had to be aborted owing to heating up of a remnant of an old spinal cord stimulator. CT revealed squamous cell lung carcinoma with widespread metastases of the spine and pelvis, causing L1 nerve root compression. In retrospect, a lytic lesion consistent with spinal metastasis was found on CT taken 5 months previously, soon after the onset of hip pain, but this was missed by the reporting radiologist at that time. This case highlights that errors in radiology reporting are inevitable, but can be minimized by using a systematic approach to carefully review all available images to avoid missing unexpected pathology.