Rajasekharan C, Ganga V
Department of Medicine, Medical College Hospital, Thiruvanathapuram, India.
Case Rep Gastroenterol. 2011 May;5(2):330-5. doi: 10.1159/000329348. Epub 2011 Jun 10.
A number of diseases may cause right atrial mass. Primary cardiac tumors range from 0.002 to 0.25%. Intracardiac manifestation and pulmonary embolism of hepatocellular carcinoma (HCC) is a very rare finding and uncommon even at autopsy. Here we describe the case of a 32-year-old Asian man who was referred for shortness of breath lasting for a month, along with unproductive cough. He was a manual laborer with a history of diabetes, alcoholism, and smoking. Clinically he was diagnosed as having pulmonary embolism. Echocardiogram showed a mass in the right atrium. Magnetic resonance imaging showed that he had a large mass in the right atrium extending down into the inferior vena cava. Further evaluation showed that he had chronic liver disease with portal hypertension and was hepatitis B surface antigen-positive, indicating hepatitis B infection. He underwent excision of the mass, and the pathological report showed metastasis of HCC with multiple vascular emboli in the lungs. As this is the second reported case of this kind in the literature, we highlight the need of screening at least 6-monthly all patients with chronic liver disease, hepatitis B and C virus infection for the early detection of HCC.
多种疾病可能导致右心房肿块。原发性心脏肿瘤的发生率为0.002%至0.25%。肝细胞癌（HCC）的心脏内表现和肺栓塞是非常罕见的发现，即使在尸检时也不常见。在此，我们描述了一名32岁亚洲男性的病例，他因持续一个月的气短以及干咳前来就诊。他是一名体力劳动者，有糖尿病、酗酒和吸烟史。临床上他被诊断为肺栓塞。超声心动图显示右心房有一个肿块。磁共振成像显示他右心房有一个大肿块，向下延伸至下腔静脉。进一步评估显示他患有慢性肝病伴门静脉高压，且乙肝表面抗原呈阳性，表明感染了乙肝。他接受了肿块切除，病理报告显示为HCC转移，肺部有多个血管栓子。由于这是文献中报道的第二例此类病例，我们强调至少每6个月对所有慢性肝病、乙肝和丙肝病毒感染患者进行筛查以早期发现HCC的必要性。
