Once in a lifetime, like me, you may be presented with a patient being assessed for mitral stenosis who also has metastatic abdominal carcinoid. This was my case, plain film and octreotide nuclear scan to show the right parahilar metastasis. Now we all know that hepatic carcinoids can produce right sided valve disease, sometimes severe, but in this instance the pulmonary deposit is creating carcinoid effect on the left heart! Here is the echo, which looks very much like ordinary rheumatic mitral stenosis.