Case Report
Copyright ©2005 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 21, 2005; 11(15): 2357-2359
Published online Apr 21, 2005. doi: 10.3748/wjg.v11.i15.2357
Pulmonary embolization as primary manifestation of hepatocellular carcinoma with intracardiac penetration: A case report
Elod Papp, Zsuzsanna Keszthelyi, Nagy Karoly Kalmar, Lajos Papp, Csaba Weninger, Tamas Tornoczky, Endre Kalman, Kalman Toth, Tamas Habon
Elod Papp, Zsuzsanna Keszthelyi, 1st Department of Medicine, University of Pecs Medical School, H-7624, Pécs, Ifjusag u. 13. Hungary
Nagy Karoly Kalmar, Department of Surgery, University of Pecs Medical School
Lajos Papp, Heart Institute, University of Pecs Medical School, H-7624, Pécs, Ifjusag u. 13. Hungary
Csaba Weninger, Department of Radiology, University of Pecs Medical School, H-7624, Pécs, Ifjusag u. 13. Hungary
Tamas Tornoczky, Endre Kalman, Department of Pathology, University of Pecs Medical School, H-7624, Pécs, Ifjusag u. 13. Hungary
Kalman Toth, Tamas Habon, 1st Department of Medicine, University of Pecs Medical School, Pecs, Hungary
Author contributions: All authors contributed equally to the work.
Correspondence to: Dr. Elod Papp, 1st Department of Medicine, University of Pecs Medical School, H-7624, Pécs, Ifjusag u. 13. Hungary. elod.papp@aok.pte.hu
Telephone: +36-72-536-000 Fax: +36-72-536-148
Received: September 6, 2004
Revised: September 8, 2004
Accepted: October 8, 2004
Published online: April 21, 2005
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 pos-sible causes of recurrent pulmonary embolism. Searching for primary malignancy should include HCC as frequent cause of hypercoagulability. In case of HCC, echocar-diography is suggested because of the possibility of expansion in IVC or right atrium and tumor-embolization.

Keywords: Hepatocellular carcinoma; Intracardiac penetration; Pulmonary embolization