Clinical Image
Hepatocellular Carcinoma (HCC) Migrating to the Right Atrium through the Inferior Venacava (IVC)
Azzam AZ*
Department of General Surgery, Alexandria University, Egypt
*Corresponding author: Ayman Zaki Azzam, Department of General Surgery, Alexandria University, Alexandria, Egypt
Published: 08 Dec, 2017
Cite this article as: Azzam AZ. Hepatocellular Carcinoma
(HCC) Migrating to the Right Atrium
through the Inferior Venacava (IVC).
Clin Surg. 2017; 2: 1813.
Clinical Image
HCC has tendency to spread into the venous system but intra-cardiac involvement is considered extremely rare with very poor prognosis. These patients often exhibit symptoms of heart failure owing to flow obstruction or thromboembolism upon diagnosis. Eighty two year old gentleman presented to emergency department with jaundice, bilateral lower limbs edema and dyspnea. Laboratory results were normal with elevated alpha fetoprotein 258.3 ug/L. Ultrasound showed right hepatic lobe hepatoma in segment 6 & 7 with tumor extension into the IVC and right atrial mass lesion. Urgent CT scan abdomen showed hepatoma at segment 6 & 7 invading right hepatic vein as well as confluence of the IVC extending into the right atrium of the heart (Figure 1). Ultrasound guided FNA showed picture of hepatocellular carcinoma. Echocardiogram showed sinus rhythm with a large mass is noted in the right atrium occupying most of the cavity and extending into IVC with flow obstruction.
Figure 1
Figure 1
CT showing HCC migrating through the IVC to the right atrium (arrow).