case_images: PMC9941037_01
case_images: Lumbar and pelvic radiography. The anteroposterior and lateral views appear to have reduced L4-5 disc space and a marginal anterior osteophyte in the lumbosacral spine (LS) vertebral body (red arrow). Multiple lucent foci are also found on the left pelvic rim, femoral head, and proximal body (white arrow).
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case_images: PMC9941037_01_cureus-0015-00000034049-i01.jpg
case_images: FIG1
case_images: The chiropractor took lumbar, pelvic (Figure 1), and hip (Figure 2) radiographs as an initial imaging test and identified multiple lucent foci on the left pelvic rim, femoral head, and proximal body.
case_images: Hip radiography. Hip radiographs identified multiple lucent foci on the left pelvic rim, femoral head, and proximal body (white arrows).
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case_images: PMC9941037_01_cureus-0015-00000034049-i02.jpg
case_images: FIG2
case_images: The chiropractor took lumbar, pelvic (Figure 1), and hip (Figure 2) radiographs as an initial imaging test and identified multiple lucent foci on the left pelvic rim, femoral head, and proximal body.
case_images: Muscle pain relief. Utilization of an instrument-assisted soft tissue mobilization device (Strig Pro, STRIG, Korea) stroking the skin surface of the lumbar paraspinal muscles, gluteal muscles, iliotibial band, lateral rotators, and adductors of the left hip repeatedly with the use of lubricating cream around the left hip joint.
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case_images: PMC9941037_01_cureus-0015-00000034049-i03.jpg
case_images: FIG3
case_images: The chiropractor also reduced muscle tightness by using an instrument-assisted soft tissue mobilization device (Strig Pro, STRIG, Korea) and stroking the skin surface of the hypertonic muscles repeatedly with lubricating cream (Figure 3).
case_images: MRI of the left hip. Hip MRI identified a T2W hypointense mass (3.01x3.51x3.17cm) with marked restricted diffusion that is noted at the prostate from base to apex, with the epicenter on the right side and extension to the left side, highly suggestive of prostate metastasis.
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case_images: PMC9941037_01_cureus-0015-00000034049-i04.jpg
case_images: FIG4
case_images: F18 FDG whole-body PET-CT. Radiological carcinoma of the prostate with bone and lung metastases.
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case_images: PMC9941037_01_cureus-0015-00000034049-i05.jpg
case_images: FIG5
case_images: Numerous subcentimeter nodules were scattered in both lungs, suggestive of lung and lymph node metastasis (Figures 5, 6).
case_images: F18-PSMA whole-body PET and CT. The images confirmed the carcinoma of the prostate with numerous lung and bone metastases (white arrows). More bone metastases are detected on PSMA examination. Spotty right external iliac lymph nodes, as described, represent early lymph node metastasis.
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case_images: PMC9941037_01_cureus-0015-00000034049-i06.jpg
case_images: FIG6
case_images: Numerous subcentimeter nodules were scattered in both lungs, suggestive of lung and lymph node metastasis (Figures 5, 6).