Abstract
BackgroundCardiac metastases in hepatocellular carcinoma patients are infrequently encountered and usually associated with a very poor prognosis.Case presentationHereby, we report a case of an acute pulmonary embolism (PE) on top of HCC with direct cardiac invasion to the right atrium (RA) through the inferior vena cava with another metastasis to the right ventricular apex in the form of highly mobile cauliflower mass protruding through the tricuspid valve into RA and nearly obliterating right ventricular outflow tract in a multi-centric hepatocellular carcinoma patient.ConclusionAcute dyspnea in a patient with a long history of hepatitis C virus infection raises the suspicion of acute PE due to either hypercoagulable state induced by malignancy or by cardiac extension of the tumor which usually carries high mortality rates. To the best of our knowledge, this case is the first case in the literature to show cardiac metastases in HCC with two different pathological mechanisms.
Highlights
Cardiac metastases in hepatocellular carcinoma patients are infrequently encountered and usually associated with a very poor prognosis.Case presentation: Hereby, we report a case of an acute pulmonary embolism (PE) on top of HCC with direct cardiac invasion to the right atrium (RA) through the inferior vena cava with another metastasis to the right ventricular apex in the form of highly mobile cauliflower mass protruding through the tricuspid valve into RA and nearly obliterating right ventricular outflow tract in a multi-centric hepatocellular carcinoma patient
Right atrial invasion with right ventricular outflow obstruction and Budd Chiari syndrome was previously reported while cardiac metastases in HCC patients are rarely encountered and mostly are associated with high mortality
Urgent transthoracic echocardiography (TTE) was done revealing a large solid mass extending through the inferior vena cava (IVC) to the right atrium (RA) with another highly mobile cauliflower mass at the right ventricular (RV) apex occupying the RV cavity, protruding into RA through TV and nearly obliterating RV outflow tract into the pulmonary artery (Fig.1, video 1)
Summary
Acute dyspnea in a patient with HCC raises the suspicion of acute PE induced by either a hypercoagulable state in malignancy or by tumor thrombus through malignant cardiac extension.
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