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Castleman disease is a rare, heterogeneous group of lymphoproliferative disorders whose imaging characteristics can resemble malignancy. We present a case of a patient who initially presented with intermittent hypertension, palpitations, and chest pain. Despite a negative biochemical workup, CT imaging revealed a left retroperitoneal mass intimately associated with the left adrenal gland with 68Ga-DOTATATE positron emission tomography-computed tomography (PET/ CT) detecting uptake in the mass as well as several left para-aortic lymph nodes and bone lesions. Based on the imaging findings, the patient was taken to the operating room for resection of what was presumed to be a metastatic neuroendocrine tumour. However, the diagnosis on histopathological examination was hyalinevascular Castleman disease. While DOTATATE PET/CT has high sensitivity and specificity for neuroendocrine tumours (NETs), this case report highlights that nonneuroendocrine pathology may result in DOTATATE uptake, and that Castleman disease should be considered when encountering DOTATATE-positive masses on imaging. [ABSTRACT FROM AUTHOR] more...