Afferent Loop Syndrome with Intestinal Ischemia due to Internal Hernia after Whipple Operation for T2N1M0 Pancreatic Cancer.

Afferent loop syndrome is an uncommon complication of Whipple procedure. The often vague and non-specific presentation results in difficulty and/or delay in diagnosis, which may lead to bowel ischemia or perforation. CT can demonstrate characteristic features, yield the diagnosis of afferent loop syndrome, and predict the cause before surgical intervention. We present a rare etiology of acute afferent loop syndrome in a patient 6 weeks after Whipple procedure who was reportedly recovering well, which resulted in prompt surgical intervention.

Chronic Anthracycline-related Myocarditis Presenting as Diffuse Myocardial Calcification.

In the setting of cardio-oncology, evaluation for myocarditis is a growing indication for cardiovascular magnetic resonance (CMR). Treatment-related side effects of cancer therapies comprise the majority of myocarditis cases in cardio-oncology, and these are often secondary to anthracyclines and even the newer class of immune checkpoint inhibitors. Cardiotoxicity from cancer therapy represents an increasingly recognized etiology of myocarditis and when detected, warrants prompt management changes. The conventional CMR evaluation for myocarditis includes modules for the left ventricular structure and function, early gadolinium enhancement, and late gadolinium enhancement. Newer CMR sequences including native T1 mapping and extracellular volume fraction offer improvement in diagnostic accuracy from conventional CMR methods. We present a case of subacute/ chronic myocarditis related to anthracycline therapy 4 months prior that was diagnosed only after incidental diffuse myocardial calcifications on pre-treatment computed tomography raised suspicion.

Cardiac Magnetic Resonance for Diagnosis of Neuroendocrine Tumor Metastases to the Right and Left Ventricles with Carcinoid Heart Disease.

A 76-year-old male with a small bowel neuroendocrine tumor with hepatic metastases presented with new onset lower extremity swelling, bloating, and weight gain which ultimately lead to cardiac magnetic resonance (CMR) to evaluate for cardiac involvement of disease. CMR showed right and left ventricular myocardial metastases along with findings suggestive of carcinoid heart disease. The patient had severe tricuspid valve regurgitation necessitating surgical valve repair. The patient underwent bioprosthetic tricuspid valve replacement and debulking of the metastases with surgical pathology confirming neuroendocrine tumor metastases. Follow-up clinical evaluations at 3, 6, and 9 months postoperatively showed improvement in cardiac function and stable hepatic tumor burden. This case demonstrates the utility of CMR to diagnose myocardial metastases and carcinoid heart disease complicated by severe tricuspid regurgitation, which guided surgical management.