Figure 1. There is a large heterogeneous mass arising from the left adnexal region, abutting the superior border of the urinary bladder. It measures 10.9 x 14.7 x 17.9cm. The solid components are hypermetabolic (SUV_max up to 4.5).

Figure 2. There is another hypermetabolic 4.0 x 2.7cm soft tissue mass in the right adnexa (SUV_max 5).

Figure 3. In the proximal ascending colon, there is a short segment of hypermetabolic circumferential wall thickening (SUV_max 6.7).

Figure 4. There is ascites with low FDG avidity. A hypermetabolic peritoneal nodule is present in the right subphrenic space (SUV_max 3.7).

Figures 5, 6. The hypermetabolic ovarian, colonic, and peritoneal lesions are seen.

Krukenberg tumours are metastatic tumours to the ovaries, from gastrointestinal origin, characterized by bilateral metastases composed of mucin-producing, signet-ring cancer cells. Such tumours antedate the discovery of the primary tumour in up to 20%.

Ovaries can have moderately intense physiologic FDG uptake in premenopausal women, with no established SUV threshold for distinguishing benign from malignant lesions. Ovarian uptake in postmenopausal women however, is abnormal, and requires exclusion of malignancy.

This case exemplifies the utility of FDG-PET/CT in the identification of metastatic lesions, as well as in the identification of primary tumours.