A case of an intra-atrial tumor thrombus from hepatocellular carcinoma (HCC), first indicated by 67Ga-citrate scintigraphy

Progressive dyspnea and a right atrial mass in an 80-year-old man

Hepatocellular carcinoma (HCC) is among the five most frequent causes of cancer death worldwide, according to the WHO. The disease is related to alcohol abuse, viral infections, and other causes of cirrhosis, and unfortunately, in some developed countries, the incidence shows an increasing trend. Although the diagnosis of the HCC often relies upon the context of a chronic hepatopathy, some cases may present a silent course, and the initial symptoms ensue when the disease is in an advanced stage with no chance for any therapeutic attempt. The clinical picture of the HCC is varied, and unexpected forms may surprise the clinician. One of the unusual presentations of the HCC is shock by the blockage of the venous return to the right atrium by the inferior vena cava infiltration. Herein we present a case of an old patient who sought medical care complaining of dyspnea. The clinical workup disclosed a right thorax pleural effusion and imaging exams depicted a mass in the right hepatic lobe, invasion of the inferior vena cava (IVC) and the right atrium (RA). During the attempts of clinical investigation, the patient passed away. The autopsy disclosed an HCC involving the right hepatic lobe, with the invasion of the IVC and the RA. The authors highlight the importance of recognizing the bizarre presentation of not so rare diseases.

Unique association of cardiac amyloidosis and right atrial tumor thrombus in a patient with hepatocellular carcinoma

Tumor thrombus is a very rare complication observed in patients with hepatocellular carcinoma. We report a unique case of hepatocellular carcinoma with extension of tumor along the inferior vein cava into the right atrium, in a patient with cardiac amyloidosis and without any cardio respiratory distress or typical clinical findings suggestive of cardiovascular involvement from cardiac amyloidosis. Cardiac magnetic resonance imaging is a useful tool to assess intracardiac tumor extension as well as to provide myocardial tissue characterization.

Intra-atrial tumour thrombus secondary to hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality. Hepatitis B & C accounts for most HCC occurrences. It is very rare to see a tumour thrombus extending into the right atrium of the heart as a result of the invasion of HCC. This complication has a very poor prognosis as mean survival time is about three to four months. We encountered such a rare case of hepatocellular carcinoma having extensive tumour thrombus extending into the right atrium without any cardio respiratory distress or clinical finding suggestive of cardiovascular involvement.