Author(s)

AS Rangheard, C Dromain, A Loshkajian, R Sigal

Patient

female, 45 year(s)

flushes, diarrhea, palpitations and abdominal pain.

A 45-year old woman was admitted to the hospital with a 4 months history of flushing associated to diarrhea, palpitations and abdominal pain. The abdominal examination showed a nodular hepatomegaly. Biologically was found an urinary 5-HIAA excretion (normal ranged from 10 to 80 umol/24 h). An ultra-sonography and an abdominal computed tomography (CT) were performed. CT exploration : After administration of an oral contrast medium, a dual-phase helical CT was performed : before and after injection of a iodine contrast medium (100 ml).

Carcinoid tumors arise from the bowel distal to the ligament of Treitz(1).Their typical manifestion is the carcinoid syndrome with flush,diarrhea and palpitations(3),associated to an urinary 5- HIAA excretion(2). Carcinoid tumors tend to metastasize to liver, bone and lung (1). Hepatic metastases are hypervascular: isodense relative to the liver, and become hyperdense after injection of a iodine contrast medium (1). The primary tumor is not always identified on CT examination because of its relatively small size(4).When it is seen, it appears as a soft tissue mass involving the bowel, or a focal bowel wall thickening. CT frequently reveals secondary mesentery changes as masses associated with radiating soft tissue strandS (1;4).