0:00

Was to one more case and then we can call it a day.

0:03

Right lower quadrant pain 55 year old paint.

0:06

So right lower quadrant paint, let's go post contrast

0:09

image.

0:27

I know the group likes reformats, I like reformats as

0:30

well in this case.

0:41

Alright, a lot of people people really like this one, okay.

0:46

Good. Good. Good. Good. Good good so good

0:49

so good. So we all right. All right. All right, you guys you guys

0:52

are too much. Okay. Everyone's all over the car. All

0:55

right. This is a car snowing. Okay,

0:58

The Coop knows there of course. No, it's that's awesome. So I

1:01

want to show this case for a few reasons. I like

1:04

I like car snow tumors. It's nice because you can think of a differential as well.

1:07

And so you see a mesenteric mass here. We see some califications. I

1:10

really like the oh, maybe

1:13

I don't oh, yeah, there's a little bit of speculation. So almost

1:16

feels like some vessels or tether to this location see another

1:19

small note over there. And the reason I want to show this case.

1:24

Well, I actually got the green light that I can go a little bit longer. So maybe

1:27

I'll show the last case it won't be that much longer after this case. So we'll do that

1:30

and whoever needs to jump off can jump off. But the reason I like

1:33

this case is you know, listen to group has seen it seems that the

1:36

group knows their cars noids and that's fine. We'll talk a little bit about that. But one

1:39

thing that I urge the group to do is when you see your car's

1:42

noise and you've sort of quote unquote Master to diagnosing

1:45

a carcinoid

1:48

Way, I kind of you know the next step which can we find the primary?

1:52

Right. That's what I always look for. Let's look

1:55

for the primary because I don't know and I have a luxury

1:58

of time and an academic practice to do that. I understand that but

2:02

I think that's sometimes make these case interesting and so

2:05

can we find the primary? I think somebody said it they saw the

2:08

primary.

2:09

and and it's gonna be tough for me to

2:12

to sort of show it to you to have

2:15

people chime in where it is, but they called them the ilium that be a

2:18

great guess if you guessed it, but if you actually saw it

2:21

good on you.

2:23

Right over there.

2:25

It's right over there. Let me window it for you.

2:28

Alright, there's a mass over there. There's some calcifications of

2:31

that mask that's gonna be the primary and one of the things that our

2:34

surgeons have told us is that oftentimes you can see right over there

2:37

is that you'll be almost there may

2:40

be more than one primers. You'll see one lesion you may there

2:43

may be others right adjacent to it. And so have a look in

2:46

the bowel loops and just see if you can window it to a point where you can actually

2:49

see the primary in this case. We can see it right over

2:52

there.

2:53

And so let's just go through this PowerPoint to

2:56

just review some teaching points. It's a neuroendocrine

2:59

tumor it often arises in the GI tract other

3:02

sites are less common.

3:04

Almost, you know, we think about a traditionally in the ilium,

3:07

but it can occur in other places in the bowel. We all know about carcinoid syndrome.

3:10

It's when you have the meths to the liver with a

3:13

spectrum of findings right due to the serotonin release and

3:16

you're looking primarily for the mesenteric mass

3:19

remembering that the mesenteric mass is the nodal metastasis. It's

3:22

not the primary tumor itself. It's the noble metastasis

3:25

from a lesion in the

3:28

bowels to look at the loops and bowels. See if you can see a similar appearing mask somewhere

3:31

there 70% of some pumpkin countifications often

3:34

speculated margins and they will tether

3:37

adjacent Loops of bowel right and vessels and

3:40

they are quite often hypervascular. And

3:43

so particularly you're looking for liver mats. It's important to do

3:46

these studies correctly when we do in arterial phase through the liver. Otherwise, you

3:49

may miss these liver metastases.