This case highlights accurate definition of an RCC lymph node with PSMA PET/CT imaging and its utility in augmenting excision of presumed malignant intra-abdominal lesions. Our treatment approach demonstrates the potential utility of CT-guided methylene blue injection for intra-abdominal lesion localization and PSMA PET/CT in the assessment of RCC nodal metastasis. Given the atypical, contra-lateral location of this suspected metastasis, further characterization was sought through 68-gallium prostate specific membrane antigen (PSMA) positron emission tomography (PET)/CT, which demonstrated PSMA-ligand lesion uptake (Fig. [Extracted from the article]