Hepatocellular carcinoma with tumor thrombus extends to the right atrium and portal vein : a case report

Víctor Vargas Blasco, Diego Gomez-Puerto, Oriol Mirallas, Judit Vidal-González

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Hepatocellular carcinoma (HCC) is the most important primary malignant liver disease. A large proportion of patients with advanced HCC have macrovascular invasion. HCC tends to infiltrate vascular structures, particularly the portal vein and its branches, and more rarely, the hepatic veins. The intravascular tumor thrombus can affect the inferior vena cava (IVC) or even the right atrium (RA), the latter having a poor prognosis. HCC is one of the most aggressive malignant tumors. Tumor thrombus (TT) formation in advanced HCC stages is common and usually involves the hepatic or portal veins. Herein, we report a 69-year-old woman who presented with dyspnea to the emergency department. A ventilation/perfusion lung scan was performed, ruling out pulmonary embolism. Hepatopulmonary syndrome and portopulmonary hypertension were discarded with contrasted echocardiography, but a mass in the RA was detected and confirmed by cardiac magnetic resonance imaging. Abdominal computed tomography showed a liver mass with a dynamic enhancement pattern compatible with HCC and an intraluminal IVC mass extending from the hepatic vein into the RA. HCC with TT expansion to IVC and RA is rare and indicates poor prognosis. HCC with TT expansion to IVC and RA is rare and indicates poor prognosis. There is no consensus about anticoagulation or other interventions in these patients.
Original languageEnglish
Pages (from-to)1128-1135
Number of pages8
JournalWorld Journal of Hepatology
Volume12
DOIs
Publication statusPublished - 2020

Keywords

  • Hepatocellular carcinoma
  • Alpha-fetoprotein
  • Tumor thrombus
  • Right atrium
  • Sorafenib
  • Case report

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