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Midgut carcinoid tumors are rare neuroendocrine tumors that can spread to the intestinal mesentery. Although the mesenteric tumor is usually the first finding due to abdominal discomfort, some patients with hepatic metastases might experience symptoms of carcinoid syndrome. We present the case of a 74 year old male with weight loss, diffuse abdominal pain, facial flushing and diarrhea for about 2 months who was diagnosed with an ill-defined mesenteric mass andhepatic, pulmonary and lymph node metastatic lesions. To better characterize the hepatic lesions, contrast-enhanced ultrasonography (CEUS) was performed. It revealed hypervascular lesions in the arterial phase and complete washout during the portal phase, suggestive for liver metastases. Surprisingly, a reflux of contrast into the inferior vena cava was also noticed in the arterial phase. This can be an uncommon finding on contrast-enhanced ultrasound (CEUS) or computed tomography (CECT) that may indicate right-sided heart disease or high flow contrast injection rates. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) confirmed the diagnosis of peripancreaticlymph node and liver metastases of neuroendocrine tumor. This case report illustrates the role of ultrasound imaging for the diagnosis of rare tumors such as carcinoid tumors and also a peculiar finding on liver CEUS. [ABSTRACT FROM AUTHOR]