Hepatocellular Carcinoma with Right Atrial Metastasis

Cardiac tumours may be primary or secondary-metastatic (malignant). Secondary cardiac tumours are much more common than primary cardiac tumours. Their frequency on large anatomical studies varies between 3.4% and 13.9%. Though cardiac metastases may originate from any malignant tumor, melanomas have the greatest propensity for cardiac involvement, and also carcinomas of the thorax, including breast, lung, and esophageal [12,13]. The routes of metastasis include direct invasion, hematogenous, lymphatic, or transvenous, especially through the inferior vena cava [9,10]. Cardiac involvement should be suspected or sought in any patient with a known malignancy who develops new cardiovascular signs or symptoms. Imaging methods - echocardiography, computed tomography (CT) and MRI, are essential in establishing the diagnosis and the invasion of the tumour in the cardiac cavity. The severe evolution of secondary cardiac tumors depends on the extension of the primary tumour, but also on the severity of the clinical cardiac manifestations. Generally, the treatment is surgical. A correct diagnosis is important in the clinical setting since cardiac metastases are able to induce sudden cardiac death1. Primary hepatocellular carcinoma (HCC) is the sixth cause of cancer in the world and the second cause of cancer mortality worldwide, with more than 830,000 deaths recorded annually2. We present a case of HCC growth into the vena cava inferior (VCI) and invasion into the right atrium (RA).