Extracardiac uptake on SPECT MPI, seen with physiologic radiotracer distribution, benign or malignant neoplasm, infection, inflammation, or granulomatous disease, may confound the accuracy of MPI or lead to unsuspected pathology. A 38-year-old woman with end-stage renal disease on hemodialysis had SPECT MPI for renal transplant preoperative risk stratification, showing left anterior descending artery ischemia and an intense extracardiac soft tissue focus adjacent to the diaphragmatic right ventricle concerning for focal infection related to prior coronary or gastric surgeries or tumor. CT revealed focal herniation of liver containing a flash-fill hemangioma into the left hemithorax accounting for this focal uptake.