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Ultrasound

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1057 - Diagnostic Ultrasound Identifies Mass in Atypical Case of Groin Pain

Thursday, February 22, 2024
5:00 PM – 6:30 PM EDT
Case Diagnosis: Metastasis of jejunal carcinoid tumor to the right groin.

Case Description: Patient is a 72-year-old male with a past medical history of malignant carcinoid tumor of the jejunum resected in 2019, who presented to the outpatient Physiatry clinic for eight months of constant, severe right anterior groin pain. The pain was worsened with laying flat and strenuous exercise, and refractory to conservative management, including Meloxicam and Gabapentin. CT of the chest, abdomen and pelvis and MRI of the pelvis did not show lymphadenopathy or a pain source. Tumor markers were downtrending. A diagnostic ilioinguinal and iliohypogastric nerve block provided six hours of pain relief, prompting the patient to return to Physiatry a month later for repeat injection. A diagnostic ultrasound was then done, which found visible inguinal lymph nodes and a hypoechoic mass in the region of the femoral nerve concerning for malignancy.

Discussions: Metastasis of small bowel neuroendocrine tumors to the inguinal region is rare. The presentation of persistent right groin pain which improved with ilioinguinal and iliohypogastric nerve block, and lack of findings on prior CT and MRI, further complicated this diagnosis. The use of diagnostic ultrasound in identifying the underlying pathology was critical in finding and treating this patient’s cancer.

Conclusions: Biopsy of the mass abutting the femoral nerve found well-differentiated neuroendocrine tumor cells. PET imaging revealed numerous tumor deposits in the abdomen and pelvis. The largest deposit was in the right external iliac region, consistent with the mass found on ultrasound. He underwent a second small bowel resection, lymphadenectomy, and incomplete resection of the right groin tumor. Although the patient had extensive imaging to diagnose his pain and monitoring for cancer recurrence, the tumor causing his pain was only found on ultrasound. The role of diagnostic ultrasound in pain management and treating neuromuscular pathologies is evident in this case.