Sternal foramina in patient with hepatocellular carcinoma: A diagnostic dilemma on bone scan

Presenting known treated case of hepatocellular carcinoma, complaining of non specific backache. 99mTc methylene diphosphonate bone scan showed photopenic area in sternal body, which could be easily thought of osteolytic metastasis from hepatocellular carcinoma; however CT scan revealed it to be sternal foramina- a normal variant of sternum. The possibility of a sternal foramen should be mentioned to the clinician because infiltration, biopsy or acupuncture of this area may lead to fatal cardiac complications. Knowledge of the existence of such anatomic variants is important to avoid misdiagnosis as an osteolytic process.