To report one 70-year-old female who developed symptomatic thoracic spinal tuberculosis with asymptomatic right acetabular tuberculosis but was initially misdiagnosed as bony metastasis based on emission computed tomography(ECT) and transverse images of computed tomography scanning at relative regions. The patient had no history of pulmonary tuberculosis, no history of exposure to tuberculosis. Before and from the onset of her intercostal neuralgia, she had nogeneral symptoms of afternoon low-degree fever, night sweets. Blood test results revealed normal blood sedimentation rate and C-protein reaction. Following ECT indicated increased tracer uptake involving T9 vertebral body and right acetabular region, and transverse images of CT scanning at thoracic spine and pelvic region detected bony destruction at T9 vertebra and irregular low bony density at right acetabular region with lesion, she was initially misdiagnosed as bony metastasis. The neglected evidences of narrowed T8-9 intervertebtral disc space and blunt left costophrenic by X-ray also were responsible for the misdiagnosis. The case implied that when spinal lesion happened in an old patient, one should keep in mind that spinal tuberculosis might not be ruled out. Increased tracer uptaking might be found in bony tuberculosis when ECT was done.