In the management of patients with esophageal cancer, distant metastases should be excluded with positron emission tomography (PET) scan or ... presence of mediastinal lymph nodes involvement ...

In March 2002, a chest CT confirmed a right middle lobe mass, measuring 5 × 6 cm, and enlarged hilar and mediastinal lymph nodes. A bone scan 8 days later showed multiple rib metastatic foci.