Hepatocellular Carcinoma to the Right Ventricle
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Hepatocellular carcinoma (HCC) is the sixth most prevalent cancer in the world, but metastatic disease to the heart is rare. We present a case of a 63-year-old man with history of hepatitis C and cirrhosis, which had progressed to HCC. The patient had undergone two prior liver transplantations. He presented to the hospital complaining of worsening lower extremity edema. His exam was also pertinent for jugular venous distension, a 3/6 crescendo-decrescendo murmur, and hepatosplenomegaly. A transthoracic echocardiogram showed a large irregular lobulated mass in the apex of the right ventricle with a mobile pedunculated component. An MRI of the heart revealed a 4.4 × 3.4 × 4.0?cm mass within the right ventricular apex, which was subsequently biopsied and found to be moderately differentiated HCC with myocardial fragments. The patient opted out of any further therapy, or intervention, and was enrolled in hospice care.

Case Report
A 63-year-old gentleman presented to our hospital with complaints of lower extremity edema. He had a medical history of thalassemia minor with chronic anemia, hepatitis C, and cirrhosis complicated by moderately differentiated hepatocellular carcinoma (HCC) in 2005 (Figures ?(Figures11 and ?and2,2, MRI of the abdomen). The patient had undergone liver transplantation, which was complicated requiring retransplantation in 2006 secondary to rejection. Over the two years prior to this last admission, he had struggled with chronic ascites and lower extremity edema for which he had been prescribed furosemide. On presentation, he complained of worsening edema to the point of restricting his ambulation due to pain. On physical exam, he had jugular venous distention to the mid neck along with 2+ pitting edema. On auscultation, a 3/6 crescendo-decrescendo murmur was best heard over the left second intercostal space with radiation to the bilateral carotids. His abdomen was benign except for palpable hepatosplenomegaly....