Figure 6b. Patient 12. Stage IV non-small cell lung cancer in a 57-year-old man with severe right shoulder pain at presentation 9 months after left single-lung transplantation for pulmonary fibrosis. Posteroanterior chest radiograph (not shown) showed only end-stage fibrosis in the native right lung and no pulmonary nodules. (a) Posterior technetium 99m methylene diphosphonate bone scan shows a focal area of increased radiotracer uptake in the scapula (straight arrow). There is a second focus in the left posterior sixth rib (curved arrow). (b) Transverse chest CT (10-mm collimation, bone window) scan obtained with the patient in a prone position for biopsy shows fibrosis and multiple nodules (arrows) in the native right lung. Transthoracic needle aspiration of the scapula confirmed metastatic non-small cell cancer.