Acute heart failure caused by a giant hepatocellular metastatic tumor of the right atrium

Abstract

We present a symptomatic 40-year-old cirrhotic man who presented with sudden onsets of syncope. Echocardiography revealed right ventricular outflow track obstruction caused by a huge right atrial mass. The tumor was surgically excised under cardiopulmonary bypass. Although no primary cancerous lesion in the liver was detected, histopathology revealed that the mass was a metastatic hepatocellular carcinoma. The aim of this report is to show the value of urgent preoperative computed tomography and its contribution in the operative strategy. The importance of urgent surgical treatment with tricuspid valve sparing tumor resection is emphasized even though the prognosis for such patients is dismal. We also discuss the further management options of such rare cases

Ectopic hepatocellular carcinoma in the adrenal gland with inferior vena cava thrombosis and right atrial extension

“…On the other hand, carcinomas of the adrenal glands, in advanced stages can, very rarely, invade the IVC and extend, through it, up to the right atrium. Right atrial tumors show a variety of clinical presentations, such as syncope, pulmonary embolism, or even acute heart failure, which are attributed mainly to their size and obstructive effects 2 …”

“…Predisposing factors include chronic hepatitis B and C infection and cirrhosis due to chronic liver disease 1 . Metastasis of HCC to the heart is well documented 2 . On the contrary, ectopic HCC presence in the adrenal gland is extremely rare 3 .…”

Hepatocellular Carcinoma with Atrial Extension: A Case Report

“…Overall, patients may be asymptomatic or present with non-specific symptoms such as dyspnea, chest pain, presyncope or syncope, cough, fever and/or hemoptysis. Physical findings include peripheral edema, systolic murmur with diastolic rumble over the tricuspid valve, and improvement of symptoms with left lateral decubitus [17].…”

Mobile right atrial thrombus with pulmonary thromboembolism in a patient with advanced hepatocellular carcinoma and disseminated tumor thrombosis

“…[8] RA thrombi are commonly described in patients with atrial fibrillation/flutter, indwelling transvenous pacing leads or patients on prolonged central venous catheters. Primary thrombi develop within the RA ( in situ thrombi) and are usually immobile attached to atrial wall.…”

“…Intra atrial thrombosis of HCC, if large and obstructive can present as right heart failure and is a potentially life threatening condition with high risk of death either due to acute PE or acute obstruction of the tricuspid valve or both. [ 8 ] RA thrombi are commonly described in patients with atrial fibrillation/flutter, indwelling transvenous pacing leads or patients on prolonged central venous catheters. Primary thrombi develop within the RA ( in situ thrombi) and are usually immobile attached to atrial wall.…”