Metastases of hepatocellular carcinoma to the heart.

Abstract

A 63-year-old, nonalcoholic man presented with abdominal distension, edema of the lower extremities, and weight loss of 6 months duration. Examination revealed a cachectic and icteric patient with elevated jugular venous pressure. Ultrasonography of abdomen revealed a large hyperechoic mass in the right lobe of the liver infiltrating the intrahepatic part of the inferior vena cava. Transthoracic echocardiography revealed a mass of size 2.73 9 4.8 cm occupying the right ventricular cavity with no intrinsic mobility and without any right ventricular outflow tract gradient. Modified subcostal view taken to visualize the inferior vena cava showed tumor thrombi along the vessel wall. There was no mass in the right atrium (RA), although the right atrial wall appeared thick (Fig. 1). Contrastenhanced thoracoabdominal computerized tomographic imaging confirmed the presence of a well-defined lobulated moderately enhancing mass lesion in the right lobe of liver on arterial phase, approximately measuring 5 9 7 cm. Cardiac computerized tomography demonstrated a nodular subcentimeter homogeneous right ventricular mass infiltrating the ventricular wall, tricuspid valve, and interventricular septum (Fig. 2). The differential diagnoses in this case were thrombus, Loeffler syndrome, and tumor with metastasis of hepatic malignancy to the right ventricle (RV) being the most likely possibility. Computerized tomography-guided aspiration cytology of the hepatic mass confirmed the diagnosis of hepatocellular carcinoma (HCC). The patient underwent two cycles of systemic chemotherapy; however, he subsequently developed progressive hepatic failure and died of the same after 3 months. The patient’s next of kin denied consent for post mortem.