Background: Suspicious bone lesions are very common and often need a pathohistological verification. Surgical (open) and percutaneous image guided biopsies can be used to get a sample for pathology analysis. As the barriers of lesion compartment shouldn’t be crossed due to risk of dissemination, transarticular approach is not advised. Case study: We present a case of 57-year-old female patient with lung cancer history and left knee pain. Lytic lesion in lateral femoral epycondile with fluorodeoxyglucose (FDG) uptake was confirmed by positron emission tomography with computed tomography (PET/CT). Surgical biopsy was performed and pathohistological analysis showed no tumor cells. A month later a computed tomography (CT)-guided percutaneous bone biopsy with CT arthrography was performed and pathohistological analysis confirmed metastatic lesion. Conclusion: CT-guided percutaneous bone biopsy is a safe, effective and minimally invasive procedure. CT arthrography can add some additional information for anatomical positioning in order to avoid transarticular approach in reaching the targeted lesion.