Aberrant right gastric vein mimicking hepatic spread of prostate cancer on PSMA-PET/CT

Hepatic vasculature can exhibit a wide variety of variants, some of which may resemble pathologic findings. In this case, a 53-year-old man presenting for staging of biochemically recurrent prostatic adenocarcinoma was found to have focally increased prostate-specific membrane antigen (PSMA) tracer uptake on positron emission tomography (PET) imaging in hepatic segment IV. This finding was initially concerning for hepatic metastasis of the patient's primary prostate adenocarcinoma. However, the area of radiotracer uptake was not associated with a discrete lesion on CT, and the geographic morphology of the uptake raised the possibility of a vascular etiology. Magnetic resonance imaging (MRI) of the liver showed no hepatic metastases and confirmed the presence of an aberrant right gastric vein directly perfusing the corresponding portion of hepatic segment IV. This case highlights PSMA uptake in the liver secondary to vascular variants as a potential mimic for metastatic disease on PSMA-PET/CT.