Modern therapeutic strategies in the last decade have radically changed the approach to the oncologic patient with metastatic disease. Not infrequently today metastases are managed more aggressively and addressed in a multidisciplinary way with extremely encouraging results in terms of both survival and disease control. There have been equally revolutionary changes in diagnostic imaging, with renewed attention to early diagnosis of both local and distant recurrence, in order to prompt timely radical intervention. The distribution of metastases is affected by characteristics of the primary improved survival of neoplastic patients and the routine imaging follow-up have resulted in greatly increased detection of metastatic malignancies with less than typical appearance and behaviour.