Interesting ImagesDecreased Vision and Headache as the Initial Symptoms of Hepatocellular CarcinomaXu, Tingting MD; Zhang, Xinyi MD; Cao, Jianpeng MD; Chen, Yue MDAuthor Information From the Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University; and Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, Sichuan, People's Republic of China. Received for publication December 29, 2019; revision accepted March 11, 2020. Conflicts of interest and sources of funding: none declared. Correspondence to: Yue Chen, MD, Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, No. 25 TaiPing St, Jiangyang District, Luzhou, Sichuan 646000, People's Republic of China. E-mail: firstname.lastname@example.org. Clinical Nuclear Medicine: October 2020 - Volume 45 - Issue 10 - p e427-e429 doi: 10.1097/RLU.0000000000003063 Buy Metrics Abstract Sphenoid sinus metastasis is extremely rare. Herein, we report a case of occult hepatocellular carcinoma with initial symptoms of decreased vision and headache, which were caused by sphenoid sinus metastasis. A 44-year-old man recently complained of bilateral decreased vision and headache. Head MRI showed a soft tissue mass in the sphenoid sinus. Pathological examination of the resected sphenoid sinus mass indicated metastatic carcinoma. Subsequently, 18F-FDG PET/CT and immunohistochemical analysis of the sphenoid sinus mass confirmed the hepatic origin of the primary lesion. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.