Ileal carcinoid neoplasm with liver metastasis (Panel A, arrows) was diagnosed recently in this 38-year-old man. Surgical treatment had been scheduled, combining ileo-colectomy and liver transplantation. As the patient complained of dyspnoea on exertion, transthoracic echocardiography (TTE) was performed, which revealed massive pulmonary and tricuspid regurgitation. Left ventricular ejection fraction and left-sided valves were normal. Dose-modulated cardiac computed tomography (CT) (VCT Light Speed 64, General Electric, Milwaukee, WI, USA) was performed to eliminate coronary artery disease before surgery ( Fig. 1 ). Coronary arteries were normal. Multiplanar multiphase reconstruction showed enlarged right cavities, and thickening and retraction of the tricuspid valve and subvalvular apparatus, including chordae and papillary muscles (Panels B, C and D). Tricuspid valve closure was incomplete during systole (Panel C, arrow; Video 1). The pulmonary valve was also thickened and non-coapting at diastole (Panels E, F; Video 2). Moderate cardiac effusion was visible (Panel D, arrow). Although the impact of CT was limited for planning the treatment of cardiac carcinoid disease, it provided a comprehensive depiction of the anatomy of the right-sided cavities and pulmonary valve. The limits of CT must be acknowledged: it cannot assess or quantify valve regurgitation, pulmonary artery pressure or patent foramen ovale (PFO). Also, the temporal resolution of CT does not allow detailed assessment of valve motion compared with TTE.
