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Tumour thrombosis of the inferior cava vein is usually associated with primary renal cell cancer. To our knowledge, this is the first case reported of adrenal metastasis of breast cancer extending into the inferior vena cava. There are few references in the literature documenting this extension with positron emission tomography (PET) and enhanced computed tomography (CT). The authors focus on the role of combined PET-CT imaging in the accurate detection of malignant thrombus.