Right Bochdalek Hernia With Herniated Ureter Mimicking Metastatic Prostate Cancer on a 68Ga Gozetotide Scan

A 78-year-old man with prostate cancer underwent 68Ga-Gozetotide PSMA-targeted PET/CT. PET/CT images demonstrated avid primary prostate cancer and a focus of increased uptake in the right upper abdomen that initially appeared suspicious for metastasis. On axial PET/CT images, this focus localized to a horseshoe-shaped structure in the thorax. It showed a subtle communication with the right kidney through a Bochdalek hernia. The possibility of an anomaly rather than a metastatic lesion was raised. Further correlation with prior diagnostic contrast-enhanced CT scans confirmed the finding of a herniated ureter containing radioactive urine. This rare anomaly is a previously unreported pitfall in PSMA-targeted PET imaging.