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We report the case of a patient who showed right pulmonary hila lung adenocarcinoma with lymph node metastasis and bone metastasis.The case of mediastinal lung adenocarcinoma was misdiagnosed as lymphoma by 18F-fluorodeoxyglucose positron emission tomography/computed tomography imaging.A 52-year-old man with a health checkup was found his right underjaw and cervical lymph node enlargement.a PET-CT scan showed: the anterior mediastinum soft tissue with SUVmax 9.1; the right hilar nodule of the lung , 1.8*2.3cm, with SUVmax 9.6 ; the mediastinum,right underjaw and cervical,supraclavicular et cetera lymph node metastasis and bone metastasis.Fine needle aspriation biopsy of lymph node in the right underjaw showed lung adenocarcinoma metastasis.When the primary lung cancer is small or hidden, mediatinal lymph node metastasis caused mediastinum widened, mediastinal lung cancer is easly misdiagnosed as mediatinal disease.