Figure 4: Follow-up HRCT chest [Figure 4, upper panel] showed rapid increase in size of the right lung nodule (black arrow) and a new sub-pleural lesion in upper lobe of left lung. It also showed a right paratracheal node (long green arrow) with cutaneous nodules. Re-staging fluorodeoxyglucose-positron emission tomography/computed tomography [Figure 4, lower panel] demonstrated hypermetabolic bilateral lung nodules (yellow arrows in image on left). It also showed a new metabolically active precarinal node (yellow arrow with SUVmax 7.03). The features were suggestive of rapid disease progression