Abstract
A 69-year-old woman had experienced resistant edema of lower extremities and progressive dyspnea on exertion for two months. The pa-tient visited our emergency room owing to ex-acerbation of her dyspnea symptom. Echocar-diography demonstrated a mobile mass in the right atrium. Transesophageal echocardiogra-phy revealed a right atrial mass arising from the inferior vena cava which was partially mobile. The patient underwent urgent open heart sur-gery with resection of the right atrial mass and curettage of the tumor thrombus in the inferior vena cava. Histologic examination of the re-sected right atrial mass revealed the features of metastatic hepatocellular carcinoma. Subse-quent work-up revealed that alpha-fetoprotein level was 3780 ng/ml. Abdominal echocardi-ography showed a tumor mass in the right lobe of the liver. The post-operative course was complicated by pneumonia, sepsis, and multi- organ failure. The patient died 48 days after surgery.
Highlights
Intracardiac metastasis of hepatocellular carcinoma (HCC) is rare
The reported incidence of right atrial metastasis in hepatocellular carcinoma ranges from 0.67% to 4.1% [4,5]
Hepatocellular carcinoma tend to extend from the hepatic vein to the inferior vena cava and into the right atrium
Summary
Intracardiac metastasis of hepatocellular carcinoma (HCC) is rare. Before the era of echocardiography, antemortem diagnosis of this condition was difficult and the condition was usually an incidental finding during autopsy. Since the widespread application of two-dimensional and transesophageal echocardiography in general practice, diagnosis of this condition has increased [1,2,3]. This study presents a case of previously un-diagnosed HCC presenting with dyspnea and resistant leg edema.
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