Role of computed tomography angiography in detection and staging of small bowel carcinoid tumors

Figure 6 Ileal Carcinoid. A 53-year-old male with stage IV ileal carcinoid tumor, who presented acutely with small bowel obstruction and a history of several months of weight loss, crampy abdominal pain and distention. The patient underwent exploratory laparotomy with surgical resection of an ileal mass (biopsy-proven carcinoid) with primary anastomosis. A large mesenteric mass involving the main superior mesenteric vein and bilateral liver metastases were not resectable. A: Coronal venous phase computed tomography (CT) image shows a hypervascular mass in the wall of a distal ileal loop (arrow) representing the primary carcinoid tumor; B: Coronal venous phase CT image slightly more anterior shows dilated small bowel (arrowhead) with mural thickening and hypoenhancement, compatible with small bowel obstruction and suggestive of hypoperfusion. A portion of a mesenteric nodal mass (arrow) representing regional metastatic disease is shown (arrow); C: Serial axial CT images from the venous phase acquisition; Left: a dilated small bowel loop proximal to the obstruction demonstrates normal bowel wall enhancement and thickness; Middle: Compare the wall thickness and enhancement of the bowel wall at the site of the primary tumor (circumferential mass, invading the mesentery on the left side, arrowhead); Right: The next slice shows the hyperenhancing bowel wall mass (arrowhead) directly abutting the mesenteric lymph nodal metastatic conglomerate mass (arrow); D: Axial arterial phase computed tomography angiography (CTA) image shows the hypervascular mesenteric mass (arrow) reflecting regional lymph node metastatic disease; E: Coronal arterial phase CTA image shows the hypervascular mesenteric mass (arrowhead) reflecting regional lymph node metastatic disease. Hypervascular liver metastases (arrows) are depicted.