SHM Converge Scientific Abstract ePoster Gallery-Tricky Tricuspid: Metastatic Carcinoid Tumor Masquerading as Severe Tricuspid Insufficiency

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This case highlights an uncommon cause of severe tricuspid valve disease: carcinoid heart disease (CHD) secondary to a metastatic neuroendocrine tumor.<br /><br />A 46-year-old man with hypertension and macular edema was referred for uncontrolled blood pressure and bilateral leg edema. Initial echocardiography showed reduced left ventricular ejection fraction (35–40%) and moderate-to-severe tricuspid regurgitation, initially raising concern for Epstein’s anomaly. A transesophageal echocardiogram then revealed tricuspid valve thickening and torrential tricuspid insufficiency, findings consistent with CHD.<br /><br />Further workup with DOTA-TATE PET/CT demonstrated somatostatin receptor–positive hepatic metastases and abnormal uptake in the terminal ileum, suggesting a small bowel neuroendocrine primary. Chromogranin A was markedly elevated (>1,900), and liver biopsy confirmed metastatic neuroendocrine tumor. Only after the diagnosis was suspected did the patient report a two-year history of intermittent flushing, diarrhea, and mild weight loss—classic carcinoid syndrome symptoms that had previously gone unrecognized.<br /><br />The patient underwent transarterial chemoembolization of both hepatic lobes and began monthly lanreotide therapy. He is being evaluated for tricuspid valve replacement and will likely need resection of the primary tumor in the future.<br /><br />The case underscores several important points: CHD may present before carcinoid syndrome is recognized, metastatic disease can be discovered during evaluation for cardiac abnormalities, and atypical presentations make diagnosis challenging. It also emphasizes the need for a multidisciplinary approach involving cardiology, oncology, surgery, and interventional radiology to individualize treatment and improve outcomes.

Asset Subtitle

Faith Seltun

Meta Tag

Author List Faith Seltun, Sindhu Muppala, Thomas McCoy, Venkataraman Rajagopalan

Category Clinical Vignettes

Concept Carcinoid Heart Disease

Concept Tricuspid Regurgitation

Concept Echocardiography

Concept Metastatic Neuroendocrine Tumor

Concept Carcinoid Syndrome

Distinguished Non-Finalist

Presenter Organization UPMC Harrisburg

Presenting Author Faith Seltun

Track Adult

Keywords

carcinoid heart disease

tricuspid regurgitation

neuroendocrine tumor

metastatic liver disease

carcinoid syndrome

DOTA-TATE PET/CT

chromogranin A

lanreotide

transarterial chemoembolization

tricuspid valve replacement

Carcinoid Heart Disease

Tricuspid Regurgitation

Echocardiography

Metastatic Neuroendocrine Tumor

Carcinoid Syndrome