Gallbladder visualization represents a rare incidental finding when using somatostatin receptor–targeted SPECT radiopharmaceuticals such as 111In-octreotide. We present the case of a 30-year-old man with pseudomyogenic hemangioendothelioma who underwent 68Ga-DOTATATE PET/CT for restaging of metastatic disease and subsequent treatment with peptide receptor radionuclide therapy with 177Lu-DOTATATE. Posttherapeutic SPECT/CT, but not pretherapeutic or posttherapeutic PET/CT, showed gallbladder visualization, evidencing 177Lu-DOTATATE excretion into the bile. This case highlights that biliary 177Lu-DOTATATE excretion may represent a rare mimicker of hepatic metastases and emphasizes the role SPECT/CT for precise anatomical correlation to avoid misinterpretation.