Hepatocellular carcinoma with metastasis to right atrium--a report of three cases

Hepatocellular carcinoma (HCC) is one of the most common neoplasma in Taiwan. The tumor itself has the tendency of extension into the venous system, such as to the portal vein, hepatic vein and inferior vena cava (IVC), but intra-atrial metastasis is unusual. Antemortem diagnosis was difficult before the availability of two-dimensional echocardiography (2-DE). Sometimes, the first symptoms and signs are cardiogenic manifestations such as dyspnea on exertion, syncope, edema of the lower legs, and shock. Clinicians may mistakenly make the wrong diagnosis of heart failure. Because of this, we hereby report three cases of HCC with right intra-atrial metastasis to raise the physician's awareness. All three cases initially presented as right side heart failure. Imaging study revealed hepatocellular carcinoma with right intra-atrial metastasis. Two of the three cases died within one month after diagnosis.