Giant Cavernous Hemangioma of the Liver Without PSMA Expression

This 77-year-old man with prostate cancer diagnosed in 2016 underwent prostatectomy in 2018, Gleason score 7 (4+3). He presented with rising serum PSA with the most recent serum PSA of 1.86 ng/mL. PSMA PET/CT showed soft tissue thickening near the prostatectomy bed with intense tracer uptake and also subcentimeter mesorectal and left obturator lymph nodes that were concerning for disease recurrence. There was absent physiologic uptake throughout the left hemiliver corresponding to diffuse faint hypodensity with Hounsfield unit (HU) of 37 (normal liver HU: 47). Prior abdominal MRI in 2006 showed a large hemangioma occupying the left lobe of the liver.