False-Positive Bone Pitfall Lesion and Collateral Circulation: Don't Miss the True-Positive Lesion

We report the case of a patient followed up for squamous cell carcinoma of the buccal floor with lymph node involvement. The initial staging PET/CT revealed bone foci that were not definitively pathological in the context of a regional collateral circulation secondary to a defibrillator. A new monitoring examination, conducted due to the rapid local progression, revealed a dissociated evolution of the bone uptake adjacent to the collateral circulation, some confirming false-positives, but one indicating a real metastasis. This case illustrates that bone uptakes without morphological lesions adjacent to a collateral circulation are not easily interpretable.