Fig. 1

A 43 year-old male with SDHD germline mutation and prior excision of multiple paragangliomas. PET imaging was performed to characterise an equivocal mediastinal nodal abnormality identified on CT. Ga-68 DOTATATE (a) demonstrate very intense uptake in a right skull base glomus jugulare tumour (SUVmax = 90), which was not visible on F-18 FDG, in part, attributable to high uptake in physiologic cerebral activity (b). A left paratracheal abnormality in the mediastinum showed intense DOTATATE uptake and low grade uptake on FDG. This likely represented a further paraganglioma rather than a metastasis. The presence of 2 tumour suggests a probable germ-line mutation and would have warranted genetic testing if the germ-line mutation was not already known