A concealed carcinoid cardiac metastasis uncovered by comprehensive cardiovascular magnetic resonance-based tissue characterization: a case report

Abstract

Background Cardiac metastases of carcinoid tumours are extremely rare, and their diagnosis poses a significant challenge. A variety of techniques has been reported in the literature for this purpose, ranging from echocardiogram to the Indium-111 Octreotide, positron emission tomography using specific tracers, and biopsy. Occasionally, the diagnosis is only made post-mortem. Recently, CMR (cardiovascular magnetic resonance) has been added to the diagnostic toolkit. This case report describes the CMR sequences that can be used to characterize cardiac metastases of carcinoid tumours. Case summary A 55-year-old woman with an antecedent history of resected carcinoid tumour of the ileocecal junction underwent whole-body In-111 Octreoscan single-photon emission computed tomography in the context of her follow-up. This raised the suspicion of pericardial involvement, which prompted a CMR study. Comprehensive CMR findings were consistent with isolated carcinoid tumour metastasis embedded within the anterior papillary muscle. We describe the CMR sequences that were used to characterize the metastasis. Discussion The rarity of cardiac metastasis of carcinoid tumour makes its diagnosis challenging and warrants a high level of clinical suspicion. Cardiovascular magnetic resonance imaging proves to be an indispensable tool in the tissue characterization of such tumours.

Isolated metastasis of mediastinal carcinoid to the left ventricle: A case report

“…A variety of techniques have been reported for this purpose, ranging from echocardiogram to the Indium‐111 octreotide, PET using specific tracers, cardiovascular magnetic resonance, and biopsy. Occasionally, the diagnosis is made post‐mortem 4 . Although the majority of larger masses are detected by echocardiography, lesions smaller than 1 cm may be missed, 12 while PET/CT might contribute to earlier and more frequent detection 3 …”

Hybrid imaging of neuroendocrine tumors in the heart: Union is strength

“…The diagnostic information from a PET/CT scan is superior to that of PET or CT alone. 53 A nuclear medicine modality, PET, is fused with a high-resolution anatomical imaging modality. PET/CT offers the advantage of accurately localizing increased metabolic activity to specific anatomic locations, which may be difficult with PET alone.…”

“…There are several PET radioisotopes (Tables 1, 3) that can also be used for imaging of PHEOs and PGLs. 53,54 Table 3 contains not only the important studies and clinical cases where PET/ CT proved its diagnostic value in this field, but also previous meta-analyzes where it is clear that in patients with suspected PGLs, 18 F-DOPA PET or PET/CT demonstrated high sensitivity and specificity. 36 Calissendorf et al 17 investigated patients with ileal NETs and found a frequency of 4.3% of cardiac metastasis One patient had cardiac surgery while three were treated with somatostatin analogs.…”