A Case of Right Atrial Obliteration Caused by Intracardiac Extension of Hepatocellular Carcinoma

Abstract

As the fifth most common malignancy worldwide, hepatocellular carcinoma (HCC) is a frequently encountered clinical entity. Symptomatology associated with the diagnosis includes hepatic dysfunction and pain from capsular spread. Additionally, due to its propensity for vascular spread, extrahepatic intravascular involvement can also be seen. We present a unique case of intracardiac involvement of HCC. Originally diagnosed as acute on chronic heart failure, echocardiography revealed the symptom source – tumor obliteration of the right atrium. Clinical case presentation and management, along with radiographic images are presented. A review of the current literature highlights this uncommon presentation and the need for clinical suspicion of cardiac involvement in patients with a history of HCC presenting with heart failure.

Usefulness of a novel transarterial chemoinfusion plus external‐beam radiation therapy for advanced hepatocellular carcinoma with tumor thrombi in the inferior vena cava and right atrium: Case study

“… 1 However, tumor extension beyond the IVC to the right atrium (RA) is rare, and RA invasion is usually associated with extremely poor prognosis due to oncologic emergencies such as fatal pulmonary embolism and right heart failure. 2 , 3 Given that there is no gold standard treatment for aggressive HCC, it is empirically treated with surgery, 4 , 5 external‐beam radiation therapy (EBRT), 6 trans‐arterial chemoembolization (TACE), 7 and systemic chemotherapy 8 in selected patients. TACE is a guideline‐recommended treatment procedure for advanced HCC globally, but its therapeutic effect on RA tumor thrombi remains discouraging.…”

“…The presence of tumor thrombi in portal vein (PV) or inferior vena cava (IVC) is common in patients with HCC and has been reported in 44%–84% during autopsy 1 . However, tumor extension beyond the IVC to the right atrium (RA) is rare, and RA invasion is usually associated with extremely poor prognosis due to oncologic emergencies such as fatal pulmonary embolism and right heart failure 2,3 . Given that there is no gold standard treatment for aggressive HCC, it is empirically treated with surgery, 4,5 external‐beam radiation therapy (EBRT), 6 trans‐arterial chemoembolization (TACE), 7 and systemic chemotherapy 8 in selected patients.…”