Autosomal dominant polycystic kidney disease is a systemic hereditary disease characterized by renal cysts and sometimes involvement of the liver. We present a 65-year-old woman with autosomal dominant polycystic kidney disease on regularly hemodialysis who recently experienced intermittent right upper quadrant abdominal pain and elevated intact parathyroid hormone for more than a year. She was referred for double-phase Tc-99m sestamibi scintigraphy, under the impression of hyperparathyroidism. Apart form increased uptake in the right thyroid bed, the images showed a large photon-deficient area in the upper portion of the abdomen corresponding to the liver.