RESUMO
A 78-year-old man presented with diffuse abdominal pain, localized peritonitis and raised inflammatory markers. CT revealed an mesentery abcess with a linear high density structure in continuity with the adjacent small bowel lumen. Laparoscopy showed a perforation by a fish bone. Gastrointestinal tract perforation by foreign body ingestion is rare complication (1%). There are some risk factors and prefered locations of perforation. Time interval between ingestion and complication can vary extremely.
RESUMO
Carcinoid syndrome is often complicated by carcinoid heart disease. Deposition of carcinoid plaques on the endocardium of the tricuspid and pulmonary valves causes the typical echocardiographic iconography with thickening of the leaflets and valvular insufficiency and/or stenosis leading to right heart failure. Additionally, the fibrous plaques can be visualized with cardiac magnetic resonance using delayed enhancement sequences. Accurate assessment of the dimensions of the dilated right ventricle by magnetic resonance implicates therapeutic options and defines prognosis. We report the case of a patient with advanced right heart failure as the clue to the diagnosis of carcinoid syndrome. Echocardiography was suggestive. Advanced investigation with magnetic resonance confirmed carcinoid plaque deposition on the tricuspid and the pulmonary valves, and we also had evidence of plaque deposition in the right ventricle. Multimodality imaging is essential in the investigation of this rare disorder.
