CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 4, May 2012
e8
AFRICA
Case Report
New images in carcinoid heart disease
M KLOBUČIĆ, MH PAAR, RŠ PADOVAN, J VINCELJ, B FILA
Abstract
Echocardiography was the main imaging technique in the
diagnosis and follow up of carcinoid heart disease but in the
last decade magnetic resonance imaging (MRI) has evolved
into a new diagnostic modality. Most of the reported MRI
features were similar to those observed by echocardiography
– tricuspid and/or pulmonary valve thickening and immobil-
ity with consequent valvular dysfunction and right heart
enlargement.To our knowledge, this is the first report describ-
ing endocardial enhancement of the right cardiac chambers,
tricuspid valve and subvalvular apparatus, which corre-
sponds with histologically seen fibrous carcinoid plaques.
Keywords:
carcinoid heart disease, magnetic resonance imag-
ing, echocardiography
Submitted 30/1/11, accepted 18/7/11
Cardiovasc J Afr
2012;
23
: e8–e10
DOI: 10.5830/CVJA-2011-038
Carcinoid tumours are rare (1.2 to 2.1 per 100 000 general
population per year), slow-growing, malignant tumours arising
from the neural crest amine precursor uptake and decarboxylation
cells (APUD cells), in particular from those situated in the
gastrointestinal tract. When these tumours metastasise to
the liver, their vasoactive products (5-hydroxytryptamine or
serotonin, histamine, tachykinins, prostaglandins etc.), which
are regularly metabolised in the endothelium of the liver and
lung vasculature, can reach the circulation and thereafter produce
symptoms of carcinoid syndrome (CS), characterised by dermal
flushing, diarrhoea, bronchospasm and valvular carcinoid heart
disease (CHD). The latter is the most serious manifestation of
CS, leading to heart failure and death in 40% of all affected.
Cardiac lesions are a consequence of serotonin-induced
deposition of fibrous tissue on the endocardial surfaces of the
heart. They are mainly found on the right side of the heart and are
truly pathognomonic. Echocardiography was the main imaging
technique in the diagnosis and follow up of CHD, but in the last
decade, magnetic resonance imaging (MRI) has evolved into a
new diagnostic modality.
Case report
A 62-year-old woman was admitted to surgery in 1996 with
symptoms of small-bowel obstruction. Exploration of the
Department of Internal Medicine, Bjelovar General Hospital,
Croatia
M KLOBUČIĆ, MD,
Department of Diagnostic and Interventional Radiology,
University Hospital Center Zagreb and School of Medicine,
University of Zagreb, Zagreb, Croatia
MH PAAR, MD
RŠ PADOVAN, MD
Institute of Cardiovascular Diseases, Dubrava University
Hospital, Zagreb, Croatia
J VINCELJ, MD
Department of Surgery, Bjelovar General Hospital, Croatia
B FILA, MD
Fig.1. Echocardiography demonstrating severe thicken-
ing, retraction, shortening and almost complete immobi-
lisation of the tricuspid valve (TV) leaflets (a), leading to
severe tricuspid regurgitation (b). Severe dilatation and
trabeculation of the right ventricle (RV) with flattening
of the interventricular septum (c). Characteristic dagger-
shaped signal of tricuspid regurgitation; mild tricuspid
stenosis (d). RA – right atrium, LV – left ventricle.
