A 48-year-old man presents with episodic facial flushing, watery diarrhoea, and wheezing for six months. CECT abdomen shows an ileal mass with multiple liver metastases. 24-hour urinary 5-HIAA is markedly raised. Echocardiography is performed. Which valvular abnormality is most likely?
- A Tricuspid regurgitation with pulmonary stenosis ✓
- B Mitral stenosis with aortic regurgitation
- C Mitral valve prolapse
- D Aortic stenosis with mitral regurgitation
Correct answer: A. Tricuspid regurgitation with pulmonary stenosis
Explanation
Serotonin released by a midgut carcinoid with hepatic metastases bypasses first-pass metabolism, reaches the pulmonary circulation, and damages right-sided valves, causing tricuspid regurgitation and pulmonary stenosis through plaque-like fibrous thickening. Left-sided disease occurs only with bronchial carcinoids or a patent foramen ovale. The discriminating fact is that left heart involvement requires a bronchial primary or a right-to-left shunt.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.