Learning objectives
It is important for radiologists to have a comprehensive overview that takes into account all organs visible in any imaging examination.Diagnostic imaging studies of the heart and its diseases are usually carried out in conjunction with knowledge from clinical examination, electrocardiography, echocardiography, stress tests, and laboratory tests; nevertheless,even when this information is absent, considering the heart in the comprehensive overview enables certain cardiac alterations to be diagnosed or oriented.One disease that involves the heart, almost exclusively the right heart, is carcinoid tumor.
Background
IntroductionCarcinoid tumors originate in the enterochromaffin cells and belong to the apudoma category of tumors. They arise from the Kulchitsky cells in the crypts of Lieberkühn and grow as submucosal nodules. Carcinoid tumors are uncommon neuroendocrine tumors; their overall incidence is 1.9/100,000.They most commonly occur in the gastrointestinal tract (66%), predominantly in the small bowel (42%). They can also occur in the pancreas, lung, and ovary.Carcinoid tumors grow slowly for years. Patients usually remain asymptomatic until the tumor is very large or has metastasized, especially...
Imaging findings OR Procedure details
A wide range of imaging methods is available for the evaluation of heart involvement by carcinoid tumors. Themost important are:- Echocardiography: This should be the first technique used in cases with suspected CHS. Both the leaflets of the tricuspid valves and those of the pulmonary valves as well as their corresponding subvalvular apparatuses are thickened, often with a clublike appearance. Decreased movement with retraction and fixation without coaptation is observed, so that the valve remains partially open.Functionally, there is a combination of regurgitation and stenosis....
Conclusion
Although carcinoid tumors are rare, CHS is a severe complication that is almost always limited to the right heart valves in patients with liver metastases. There is a growing body of evidence that the hyperserotonemia that appears in CHS results in the pathological process that eventually leads to heart valve destruction and dysfunction.It is important to be aware of the multisystemic involvement of carcinoid tumors and to know the target organs that can be affected secondarily. In any symptomatic patient with a compatible context, echocardiography...
Personal Information
Angel Sanchez-Montanez Garcia-Carpintero,
[email protected] Parc Tauli, Institut Universitari UABSabadell (Barcelona) (Spain)
References
-Guidelines for the diagnosis and management of carcinoid tumours. Part 1: The gastrointestinal tract. A statement from a Canadian National Carcinoid Expert Group. J. Maroun MD, et al. Curr Oncol. 2006 Apr; 13(2):67-76.-Carcinoid heart disease. B.I. Gustafsson. Int J Cardiol. 2008 Jun 18.-Carcinoid Heart Disease. S. Bhattacharyya, et al. Circulation.2007 Dec 11; 116(24):2860-5.-Carcinoid Tumors of the Small Bowel: A Multitechnique Imaging Approach. K. M. Horton, et al. AJR AM J Roentgenol.2004 Mar; 182(3):559-67.-MRI and CT revealing carcinoid heart disease. N. R. Mollet, et al. Eur...