A 19-year-old man with osteosarcoma in the left tibia underwent resection of the primary tumor and partial transplantation of the right fibula to the defect of the left tibia. Although his postoperative course was good, he gradually came to feel fatigue and pain in his right lower leg when he walked. One year later, he underwent fluorine-18 fluorodeoxyglucose (F-18 FDG) positron emission tomography (PET). No visible accumulation was noted in the surgically treated left lower leg. But F-18 FDG showed marked accumulation in the right calf muscles. This paradoxical FDG accumulation would explain the easy fatigability and the muscular pain.
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