Abstract:We present a case demonstrating increased diagnostic difficulty in interpretation of 18F-flucyclovine PET/CT in a patient with beta-thalassemia. 18F-flucyclovine PET/CT demonstrated diffuse increased marrow activity. Additional findings of extramedullary hematopoiesis including intrasplenic extramedullary hematopoiesis are presented. Despite the background marrow activity, an osseous metastatic lesion representing recurrent metastatic prostate carcinoma was identified. This case demonstrates a spectrum of findings of 18F-flucyclovine uptake in thalassemia, which increased the difficulty of identifying recurrent disease.