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Case Reports
. 2024 Dec 6;20(2):1273-1276.
doi: 10.1016/j.radcr.2024.11.026. eCollection 2025 Feb.

Large tumor thrombus extending into the right atrium through the inferior vena cava due to hepatocellular carcinoma: A case report

Georgios Benetos  1   2 , Angeliki Vakka  3 , Eirini Solomou  1 , Vasiliki Katsi  4 , Konstantinos Tsioufis  1 , Konstantinos Toutouzas  1
Affiliations
Case Reports

Large tumor thrombus extending into the right atrium through the inferior vena cava due to hepatocellular carcinoma: A case report

Georgios Benetos et al. Radiol Case Rep. .

Abstract

This is a case report of a 54-year-old patient with hepatocellular cancer under palliative chemotherapy who admitted with dyspnea on minimal exertion and peripheral oedema over the past 5 days. Echocardiogram revealed a large echogenic mass in the right atrial cavity which did not enhance with intravenous echo contrast agent, and a distended inferior vena cava (IVC) which was occluded by echogenic material with no signs of flow. To distinguish with accuracy if the thrombus was a bland or tumor thrombus, contrast-enhanced Computed Tomography (CT) was performed. CT Pulmonary Angiography and abdominal contrast-enhanced CT showed a distended and occluded IVC by a mass that extended to the right atrium and enhanced with intravenous contrast agent, and thus the mass was considered as a tumor thrombus. Due to the impaired performance status and liver function of the patient, supportive treatment was preferred instead of a surgical or radiological intervention. Large tumor thrombus extending into the right atrium through the inferior vena cava due to hepatocellular carcinoma has a rare incidence and is associated with a poor prognosis.

Keywords: Case report; Hepatocellular carcinoma; Right atrium; Tumor thrombus.

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Figures

Fig 1:
Fig. 1
(A) Transthoracic echocardiography revealed a large echogenic mass in the right atrium (red arrow), (B) Contrast echocardiography showed that the mass in the Fig. 1A does not enhance with intravenous contrast agent, indicating that this mass may be a bland thrombus (red arrow), (C) Inferior vena cava appears distended and occluded with echogenic material and no signs of flow (between the red arrows) in the transthoracic echocardiogram.
Fig 2:
Fig. 2
(A) Computed tomography pulmonary angiography before contrast enhancement showed that the mass extends from inferior vena cava to the right atrium, (B) Computed tomography pulmonary angiography after contrast enhancement revealed that this mass enhances with contrast agent, indicating that this mass may be a tumor thrombus, (C) Sagittal view showing the tumor thrombus extending from inferior vena cava to the right atrium, (D) Coronal view showing the tumor thrombus extending from inferior vena cava to the right atrium.
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