Presentation
Raised liver function tests, flushing. Carcinoid?
Patient Data
Virtually the whole of the liver is replaced by metastatic disease.
Trace of ascites. No peritoneal nodules.
The remainder of the solid organs of the upper abdomen are unremarkable.
4.3 cm plaque of soft tissue in the small bowel mesentery with an adjacent loop of thickened ileum in the right lower quadrant.
9.8 x 9.6 cm mass centrally in the pelvis arising from the fundus of the uterus, compressing the dome of the bladder consistent with a firboid.
No infradiaphragmatic lymphadenopathy. No focal bone lesion.
Case Discussion
In view of the history of flushing and vascular liver metastases, this is highly suspicious for a small bowel carcinoid.
Note the arterial enhancement of the liver lesions on the chest acquisition. Carcinoid metastases are typically best observed on arterial phase imaging due to their vascular nature.
The patient's laboratory tests revealed a massively elevated chromogranin A of 530.6 nmol/l (normal < 6).
She proceeded to care in a tertiary center for metastatic carcinoid.
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