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

Figure 14 Recurrent metastatic small bowel carcinoid. 71-year-old female with metastatic small bowel carcinoid. Twelve years ago she had undergone a segmental distal ileal resection and liver segmental resection for metastatic carcinoid. This case illustrates advanced recurrent metastatic carcinoid with extensive abdominal and pelvic peritoneal implants and hepatic metastatic disease. A: Axial arterial phase axial image shows a calcified mass in the small bowel mesentery (arrowhead) with surrounding linear desmoplastic reaction (blue arrowhead), compatible with carcinoid tumor metastasis; B: Coronal arterial phase VRT image shows the calcified mesenteric mass (arrowhead). The patient is status post terminal ilial and proximal colonic resection with ileocolic anastomosis (arrow). Moderate ascites is present (blue arrowhead); C: Axial arterial phase axial image shows multiple metastatic omental implants (arrowheads). Ascites is present (open arrowhead); D: Many additional omental implants are noted (arrowheads) on this coronal thick slab MIP image. Ileocolic anastomosis and colonic thickening (arrow) in the setting of ascites are noted. Large segment IVB liver metastasis (blue arrowheads). VRT: Volume rendered technique; MIP: Maximum intensity projections.