Hepatocellular Carcinoma with Inferior Vena Cava and Right Atrium Tumor Thrombus

Area of Science:

• Hepatology
• Cardiology
• Oncology

Background:

• Hepatocellular carcinoma (HCC) is a global health concern, frequently leading to cancer-related mortality.
• Cardiac metastasis in HCC typically occurs via direct tumor thrombus invasion through major hepatic veins and the inferior vena cava (IVC).
• Right heart metastasis without IVC invasion, potentially due to hematogenous spread, is exceptionally rare.

Observation:

• We present a rare case of HCC with an IVC and right atrium (RA) thrombus in a young patient.
• The patient exhibited decompensated cardiac failure but tested negative for HBsAg and anti-HCV.
• This case highlights an unusual presentation of advanced HCC with intracardiac metastasis.

Findings:

• The patient had advanced HCC with a tumor thrombus extending into the right atrium.
• Despite cardiac involvement, the patient initially presented without overt cardiac failure symptoms.
• The absence of common hepatitis markers (HBsAg, anti-HCV) in this young patient is noteworthy.

Implications:

• This case underscores the importance of considering intracardiac metastasis in advanced HCC.
• Screening echocardiography should be considered for all advanced HCC patients, particularly those with vena caval involvement.
• Early detection of intracardiac thrombi can guide timely and appropriate clinical management.