title: Pulmonary embolization as primary manifestation of hepatocellular carcinoma with intracardiac penetration: a case report.
abstract: Intracardiac manifestation of hepatocellular carcinoma (HCC) is a rare condition and an uncommon finding even at autopsy. Pulmonary tumor embolism as a presenting feature of HCC has been published only twice previously. In our case report, a 63-year-old man presented with high fever and six episodes of recurrent pneumonias during the last half year. Echocardiography was performed, a solid mass was found in the right atrium. Transesophageal echocardiography proved a tumor mass in the inferior vena cava (IVC) extending into the right atrium, abdominal ultrasound revealed tumor mass in the IVC and a solid tumor in the liver. Combined liver and heart surgery was attempted in order to remove the tumor mass from both the liver and the right atrium. Acute cor pulmonale occurred during tumor removal from the right atrium and the patient expired. In addition to local factors the possibility of embolization should arise in the background of recurrent pneumonia. Occult carcinoma must be included in possible causes of recurrent pulmonary embolism. Searching for primary malignancy should include HCC as frequent cause of hypercoagulability. In case of HCC, echocardiography is suggested because of the possibility of expansion in IVC or right atrium and tumor-embolization.
authors.affiliation: 1st Department of Medicine, University of Pecs Medical School, H-7624 Pecs, Ifjusag u. 13, Hungary. elod.papp@aok.pte.hu
authors.forename: Elod
authors.initials: E
authors.lastname: Papp
authors.forename: Zsuzsanna
authors.initials: Z
authors.lastname: Keszthelyi
authors.forename: Nagy-Karoly
authors.initials: NK
authors.lastname: Kalmar
authors.forename: Lajos
authors.initials: L
authors.lastname: Papp
authors.forename: Csaba
authors.initials: C
authors.lastname: Weninger
authors.forename: Tamas
authors.initials: T
authors.lastname: Tornoczky
authors.forename: Endre
authors.initials: E
authors.lastname: Kalman
authors.forename: Kalman
authors.initials: K
authors.lastname: Toth
authors.forename: Tamas
authors.initials: T
authors.lastname: Habon
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology*; D017809:Fatal Outcome; D006325:Heart Atria / Q000473:pathology; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D011655:Pulmonary Embolism / Q000209:etiology*; D014463:Ultrasonography; D014682:Vena Cava, Inferior / Q000473:pathology