Unusual presentation of hepatocellular carcinoma: a case report

Hepatocellular carcinoma is the seventh most common cancer in men and ninth in women. The authors describe a case of an 83-year old man with a history of cryptogenic cirrhosis and a remote history of tuberculosis who presented with sudden onset of dyspnea. Screening ultrasound of the abdomen and alpha-fetoprotein levels three months before this acute presentation were not suggestive of hepatocellular carcinoma. Chest roentgenogram showed a miliary pattern of pulmonary nodules and the patient was admitted with the diagnosis of miliary tuberculosis. Biopsy established the diagnosis of hepatocellular carcinoma with pulmonary metastases.