Hepatocellular carcinoma (HCC) is recognized to have a strong tendency for vascular invasion. However, right atrial (RA) involvement is uncommon. It has been principally described as a fortuitous discovery during oncology follow-up or as an autopsy finding of patients with known HCC. We present a case of a patient whose initial HCC presentation was an RA mass found during a dyspnea investigation. Thereby, on the basis of this new finding, clinicians should consider HCC in their differential diagnosis when discovering an RA mass.
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