Spectrum of appearance of cold sternal metastases in adults

The sternum represents a relatively common site of osseous metastases in a variety of neoplasms. The usual presentation is increased tracer uptake on bone imaging; cold metastases are distinctly unusual. Additionally, these sternal lesions are often eccentric and lateral in location. This finding may be explained by the blood supply and lymphatic drainage to the sternum. Illustrated here are examples of cold sternal metastases in the presence of hot lesions elsewhere from four different primary malignancies (breast, renal, lung, and melanoma). Explanations for the photopenic appearance include an impaired blood supply and an aggressive, destructibe process.