title: An unusual presentation and way to diagnose hepatocellular carcinoma.
abstract: A 67-year-old man with a history of chronic obstructive pulmonary disease (COPD) was admitted with acute progression of dyspnoea, productive cough, fever, elevated central venous pressure, oedema and liver enzyme abnormalities. Pneumonia with secondary right-sided congestive heart failure was considered. Additional abdominal ultrasound examination confirmed by a CT scan showed a mass in the inferior vena cava (VCI) extending into the right atrium. The central liver location and impaired haemostasis rendered liver biopsy impossible. An alternative approach was discussed and guided by two-dimensional transoesophageal electrocardiography accessing the right internal jugular vein, biopsies were taken from the atrial mass with histology suggesting the presence of a hepatocellular carcinoma as the cause of acute dyspnoea.
authors.affiliation: Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis, PO Box 95500, 1090 HM Amsterdam, the Netherlands.
authors.forename: V M J
authors.initials: VM
authors.lastname: Novotný
authors.forename: V P M
authors.initials: VP
authors.lastname: van der Hulst
authors.forename: P A
authors.initials: PA
authors.lastname: van der Wouw
authors.forename: J L G
authors.initials: JL
authors.lastname: Blaauwgeers
authors.forename: P H J
authors.initials: PH
authors.lastname: Frissen
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000209:etiology; D006801:Humans; D008297:Male; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications