Silent Invasion: Isolated Right Ventricular Metastasis from Hepatocellular Carcinoma Diagnosed by Transvenous Biopsy

Although cardiac involvement is extremely uncommon, hepatocellular carcinoma (HCC) frequently spreads to the lungs, lymph nodes, bones, and adrenal glands. The right atrium is usually affected when there is cardiac involvement because of direct invasion through the inferior vena cava. We report a 71-year-old man who had exertional dyspnea and a rare presentation of HCC metastasizing to the right ventricle (RV). A sizable RV mass with septal infiltration was seen on imaging. A transvenous biopsy confirmed metastatic HCC. After starting systemic therapy again, the patient reported that their clinical condition was stable. This case underscores the value of a multidisciplinary approach to diagnosis and treatment, as well as the diagnostic utility of cardiac biopsy in assessing uncommon cardiac masses.