Incidental Detection of PSMA Uptake in Lipomatous Hypertrophy of the Interatrial Septum

PET/CT with 18 F-Piflufolastat ( 18 F-DCFPyL, trade name Pylarify) is performed to identify areas of metastatic prostate cancer. However, activity is seen in many additional organs and benign conditions. This case illustrates PSMA activity associated with lipomatous hypertrophy of the interatrial septum (LHIS), a benign, usually incidental and asymptomatic lesion with well-known uptake on FDG PET/CT. This is a potential pitfall in the interpretation of PSMA PET/CT, which should not be confused with a malignant cardiac mass. Awareness of this source of activity avoids unnecessary intervention or additional imaging.