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A solitary apical epicardiac mass was detected in a 58-year-old male, presenting with exertional dyspnoea. Radiological follow-up showed stable size of this mass. However, one year later the patient developed symptoms suiting carcinoid syndrome. ⁶⁸Gallium DOTANOC Positron emission tomography-CT showed markedly increased somatostatin receptor expression at multiple sides, including the epicardiac mass. In addition, the patient developed symptomatic carcinoid heart disease, with severe right-sided valvular dysfunction leading to congestive heart failure, for which valvular surgery was performed.   

We report this remarkable case of carcinoid disease that presents all the possible aspects of cardiac involvement, followed by a discussion concerning current treatment strategies in carcinoid heart disease.