Asymptomatic course of a metastatic mass completely filling the right atrium in a patient with hepatocellular carcinoma

Abstract

Intracardiac involvement rarely develops in patients with hepatocellular carcinoma (HCC) and its prognosis is poor. Patients generally have symptoms of sudden dyspnea or massive lower extremity edema and the clinical course may be further complicated by many fatal cardiovascular complications. Absence of cardiac symptoms or findings, however, is an unusual condition. We present a 61-year-old man with HCC who was incidentally found to have an intracavitary mass completely occupying the right atrium. He had no cardiac complaints, nor any signs of cardiac involvement. The mass was first detected by computed tomography and then confirmed by transthoracic echocardiography. The patient underwent a successful surgical resection and the histopathologic diagnosis was HCC. Unfortunately, the postoperative course was complicated by the development of acute kidney failure and, despite hemodialysis treatment, the patient died of kidney failure eight days after the operation.

Ultrasound for critical care physicians: now my heart is still somewhat full

“…Palliative resection may be necessary owing to hemodynamic compromise, but the prognosis remains very poor. In multiple case reports of tumor thrombus resection, there was no improvement in survival or outcomes (3,4). At this time, it is uncertain that resection of tumor thrombus will yield any additional benefit to our patient.…”

Hepatocellular Carcinoma with Extension to the Heart Via the Inferior Vena Cava

“…Local invasion is more common in cirrhotic patients (5). In the rare cases of HCC with tumor extension to the right atrium and inferior vena cava, most patients were either symptomatic, had cirrhosis, or both (4)(5)(6)(7)(8)(9).…”

“…Th ere may be a modest benefi t with radiation, transarterial chemoembolization, or systemic chemotherapy with sorafenib, depending on the size of the lesions (6). Palliative cardiac surgery can be used in cases of cardiac obstruction (8,9).…”

Hepatocarcinoma with metastasis to the anterior mediastinum

“…Masci et al [17] Right intraventricular metastasis from HCC in a patient who had undergone a partial hepatectomy for HCC more than two years earlier Systemic chemotherapy with cisplatin and doxorubicin Ulus et al [18] HCC who was incidentally found to have an intracavitary mass completely occupying the right atrium…”