Background: A 37 year old female presented for a 123-meta-iodobenzylguanidine (MIBG) scan. She was initially diagnosed with bilateral phaeochromocytoma three years prior after presenting with a hypertensive crisis during an emergency caesarean section. She now presents for a restaging scan with suspicion of recurrence in the setting of symptoms, increasing urinary catecholamines and a 11mm adrenal soft tissue lesion on CT.

Method and result: A whole body MIBG scan was performed followed by SPECT/CT of the chest and abdomen. Low dose multi-slice CT was performed for attenuation correction and anatomic correlation. This identified increased activity in bone including T5, right clavicle and left humerus. In addition, activity was identified in two soft tissue nodules in the left breast measuring up to 13mm. Ultrasound and fine needle aspirate (FNA) confirmed metastatic left breast phaeochromocytoma.

Conclusion: MIBG SPECT-CT was pivotal in confirming phaeochromocytoma recurrence. Contemporaneous CT allowed precise localisation of abnormal MIBG activity.