Case of the Month #166: Carcinoid Heart Disease

• Published in: Canadian Association of Radiologists journal 2010-12, Vol.61 (5), p.297-298
• Main Authors: Wardell, Stephan, MD, Mousavi, Negareh, MD, FRCPC, Tam, James W., MD, FRCPC, Kirkpatrick, Iain D.C., MD, FRCPC, Maycher, Bruce, MD, FRCPC, Jassal, Davinder S., MD, FRCPC
• Format: Article
• Language: English
• Subjects: Carcinoid syndrome; Cardiac magnetic resonance imaging; Cardiovascular disease; Echocardiography; Heart surgery; Radiology; Studies; Tomography; Tricuspid regurgitation
• ISSN: 0846-5371; 1488-2361
• DOI: 10.1016/j.carj.2009.11.012

Carcinoid tumours are relatively rare, with an incidence of 3-4 per 100,000 population per year [I]. The primary tumour is located in the gastrointestinal tract or the bronchopulmonary tree in more than 98% of cases [2]. Cardiac involvement is the presenting feature in fewer than 20% of cases but develops in more than 50% of cases [3]. The rightsided valves, with the tricuspid valve in all patients and the pulmonary valve in the majority of patients, are the major sites of cardiac involvement [3]. Left-sided heart disease is significantly less common and is usually associated with a patent foramen ovale [3]. Valvular lesions are characterized by shortened, thickened, and immobile leaflets. This leads to valvular regurgitation and can result in combined regurgitation and stenosis of the affected valve [3]. Right ventricular volume overload and dilatation may occur as a result of the tricuspid regurgitation. CMR offers additional information in terms of detailed evaluation of accurate right ventricular volumes and systolic function [3]. Our case supports the use of multimodality cardiac imaging for the diagnosis and anatomic characterization of carcinoid heart disease.