The authors report a case of unsuspected myocardial ischemia detected during CoDe FDG PET (coincidence detection fluorodeoxyglucose positron emission tomogram) which was performed for the evaluation of a solitary pulmonary nodule. Camera-based FDG PET without attenuation correction often reveals false defect in the inferior wall of the left ventricle in normals due to excessive attenuation. However, this asymptomatic patient had increased uptake in the inferior wall suggesting ischemic myocardium. The scan finding was confirmed by Tl-201 myocardial SPECT and coronary angiogram. The patient then underwent successful PTCA of mild RCA and right ventricular branch followed by right upper lobectomy for small cell lung cancer.