Pulmonary carcinoid with hepatic metastases

Case contributed by Dr Hani Makky Al Salam

Presentation

A young male patient referred with liver masses for evaluation.

Patient Data

Age: Young age
Gender: Male

Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.

Chest radiographs

X-ray

Lingular opacity is noted.

Elevated right hemidiaphragm.

An endobronchial mass lesion is noted at the superior lingular segment with heterogeneous texture. It is obstructing the lingular bronchus. 

Elevated right hemidiaphragm. Subsegemental atelectasis of right lower lobe with minimal right pleural effusion.

Enlarged liver with multiple variable-sized hypo-enhancing hepatic lesions on both hepatic lobes, suggestive of hepatic metastases.

2 hours Tc-Octreotide scan

Nuclear medicine

Tc-Octeriotide scan revealed radiotracer uptake in the chest corresponding to the lingular endobronchial lesion and hepatic uptake corresponding to the metastases.

Case Discussion

CT scan of the chest, abdomen and pelvis was performed which revealed an endobronchial lesion in the superior segment of the lingual. Multiple varying size hepatic lesion likely to be metastasis, which was confirmed by biopsy one of the lesion which turn to be a neuroendocrine tumor. Tc-Octeriotide scan was performed which revealed radiotracer uptake in the chest corresponding to the lingular endobronchial lesion and hepatic uptake corresponding to the metastases.

3 months later the patient developed shortness of breath. CTPA was performed to rule out pulmonary embolism. No emboli within the pulmonary arteries were seen however the size of the liver metastases were tremendously increased with elevation of the right hemidiaphragm. The size of the pulmonary carcinoid did not change significantly.

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