FDG PET/CT detected an insidious inguinal canal metastasis in a patient with pancreatic cancer

A 70 year old male with a history of inoperable pancreatic cancer with peritoneal metastases was evaluated by FDG PET/CT imaging for disease extent and therapy response after 4 cycles of chemotherapy. PET/CT demonstrated mildly increased uptake at the primary site within the pancreatic neck and in the peritoneum. An unexpected finding involved increased uptake in the right inguinal canal region around the patient’s known hernia. A hernia inflammation was suspected and the patient subsequently underwent surgical intervention for possible strangulation. Unexpectedly, the histopathologic evaluation of the surgical specimen revealed peritoneal metastasis in the inguinal canal. Although metastasis to this localization is rather rare, the use of PET/CT assisted in the discovery of unexpected metastasis in a rare