43 year old Chinese man with naso-pharyngeal carcinoma. He completed radiotherapy 2 years ago. On routine chest x-ray, a suspicious solitary small nodule was discovered in the right upper zone measuring 5mm in diameter. PETCT scan was done a month later and showed the nodule has increased in size to 1.4cm in diameter with SUV max uptake of 5.5. A diagnosis of pulmonary metastases was made.