Right Atrium Invasion of Tumor Thrombus from Hepatocellular Carcinoma Incidentally Found on Transthoracic Echocardiogram.

Hepatocellular carcinoma (HCC) is a highly aggressive malignancy in which tumor thrombus can invade portal and hepatic veins in late stages. However, an antemortem diagnosis of right atrial invasion by tumor thrombus is very rare and confers a poor prognosis. We report a patient with antemortem diagnosis of tumor thrombus in the right atrium incidentally found by transthoracic echocardiogram which was later confirmed with CT scan of abdomen with IV contrast. The patient was also noted to have an acute increase in alpha-fetoprotein (AFP). Our case suggests the importance of imaging studies and monitoring AFP levels in patients with long standing HCC.