Isolated Intracardiac Metastasis: The First Sign of Hepatocellular Carcinoma

Area of Science:

• Cardiology
• Oncology
• Hepatology

Background:

• Metastatic hepatocellular carcinoma (HCC) to the right atrium is exceptionally rare, posing diagnostic challenges, particularly when the primary liver tumor is unknown.
• Early diagnosis and intervention are crucial for managing rare oncological emergencies.

Observation:

• A 68-year-old male presented with heart failure symptoms, revealing a large right atrial mass via echocardiogram, initially suspected as myxoma.
• Urgent surgery successfully removed the mass, with subsequent histology confirming metastatic HCC originating from an undetected liver nodule.

Findings:

• The patient received radiofrequency ablation and sorafenib treatment for metastatic HCC.
• Despite initial aggressive management, the disease progressed to involve the inferior vena cava and portal vein over 4 years and 3 months.

Implications:

• This case highlights the potential benefit of aggressive surgical metastasectomy in prolonging survival for patients with intracardiac HCC metastasis.
• Early detection and multidisciplinary management are vital for improving outcomes in rare metastatic presentations of liver cancer.