A Rare Incidence of Hepatocellular Carcinoma With Tumor Thrombus Extending to the Right Heart

Abstract

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths and the sixth most commonly diagnosed cancer worldwide due to several common risk factors, including hepatitis C virus (HCV), hepatitis B virus (HBV), and other causes of cirrhosis. In HCC, intrahepatic vascular invasion and a tumor thrombus are commonly observed. However, the extrahepatic spread of the tumor thrombus to the heart via the portal vein, hepatic vein, and inferior vena cava (IVC) is rarely reported and is considered a poor prognostic factor. In addition, rarely, there is a risk of cor pulmonale and thromboembolism of the pulmonary vessels. Our patient also presented with this rare complication of HCC. Our patient's clinical presentation was bilateral pedal edema, moderate ascites, and abdominal discomfort with raised jugular venous pressure. These signs and symptoms are related to an impairment of the right heart caused by intracardiac tumor thrombus metastasis, leading to diastolic dysfunction. Based on these findings, echocardiography and abdominal computed tomography (CT) scan were performed with the definitive diagnosis of hepatocellular carcinoma with tumor thrombus metastases in the hepatic vein, inferior vena cava, and right atrium. The management team agreed on a conservative treatment plan based on the advanced stage of the disease and the high risk associated with aggressive treatment modalities.Unfortunately, on day 7 of admission, the patient died from a possible pulmonary embolism that led to cardiopulmonary arrest. This case underscores the importance of screening patients with a high HCC tumor burden with abdominal ultrasound and echocardiography for early detection and timely management.

Echocardiographic parameters as adjuncts to the Pulmonary Embolism Severity Index in predicting 30-day mortality in acute pulmonary embolism patients

“…Moreover, it might indicate an increased amount of embolic material and is more often met in patients with parallelly diagnosed deep vein thrombosis which itself is a sign of a higher risk of in-hospital mortality of PE patients [39]. It also accompanies malignant neoplasms and COVID-19diseases with other pathological processes affecting fatal outcome [40,41]. The 60/60 signcombining tricuspid regurgitation jet gradient of ≤60 mm Hg and AcT ≤60 ms has been introduced by Torbicki and Kurzyna and their collaborates [42,43] at the turn of the century as a marker of elevated pulmonary arterial pressure related to the presence of embolic obstacles within pulmonary arteries, increased pulmonary vascular resistance as well as elevated RV strain in acute PE.…”