Health  Vol.3 No.2 , February 2011
Echocardiographic detection of a metastatic right atrial mass in a patient with previously un-diagnosed hepatocellular carcinoma who presents with dyspnea
ABSTRACT
A 69-year-old woman had experienced resistant edema of lower extremities and progressive dyspnea on exertion for two months. The pa-tient visited our emergency room owing to ex-acerbation of her dyspnea symptom. Echocar-diography demonstrated a mobile mass in the right atrium. Transesophageal echocardiogra-phy revealed a right atrial mass arising from the inferior vena cava which was partially mobile. The patient underwent urgent open heart sur-gery with resection of the right atrial mass and curettage of the tumor thrombus in the inferior vena cava. Histologic examination of the re-sected right atrial mass revealed the features of metastatic hepatocellular carcinoma. Subse-quent work-up revealed that alpha-fetoprotein level was 3780 ng/ml. Abdominal echocardi-ography showed a tumor mass in the right lobe of the liver. The post-operative course was complicated by pneumonia, sepsis, and multi- organ failure. The patient died 48 days after surgery.

Cite this paper
nullFang, B. , Lin, C. and Yen, I. (2011) Echocardiographic detection of a metastatic right atrial mass in a patient with previously un-diagnosed hepatocellular carcinoma who presents with dyspnea. Health, 3, 82-85. doi: 10.4236/health.2011.32015.
References
[1]   Chua, S.O., Chiang, C.W., Lee, YS, Liaw, Y.F., Chang, C.H. and Hung, J.S., (1989) Echocardiographic findings of mobile atrial hepatocellular carcinoma report of five cases. Journal of Ultrasound in Medicine, 8, 347-352.

[2]   Camp, G.V., Abdulsater, J., Cosyns, B., Liebens, I. and Vamdenbossche, J.L., (1994) Transesophageal echocardiography of right atrial metastasis of a hepatocellular carcinoma. Chest, 105, 945-947. doi:10.1378/chest.105.3.945

[3]   Vlasseros, I., Tapanlis, E., Katsaros, A., Katsaros, A., Kountouras, D. and Gialafos, I. (2003) Metastatic hepatocellular carcinoma into the right atrium and ventricle: echocardiographic diagnosis and follow-up. Echocardiography, 20, 387-388. doi:10.1046/j.1540-8175.2003.03047.x

[4]   Kato, Y., Tanaka, N., Kobayashi, K., Ikeda, T., Hattori, N. and Nonomura, A. (1983)Growth of hepatocellular carcinoma into the right atrium: report of five cases. Annals of Internal Medicine, 99, 472-474.

[5]   Kojiro, M., Nakahara, H., Sugihara, S., Murakami, T., Nakashima, T. and Kawasaki, H. (1984) Hepatocellular carcinoma with intra-atrial tumor growth. Archives of Pathology & Laboratory Medicine 108, 989-992.

[6]   Takeuchi, J., Takada, A., Hasumura, Y., Matsuda, Y. and Ikegami, F. (1971) Budd-Chiari syndrome associated with obstruction of the inferior vena cava: a report of seven cases. American Journal of Medicine. 51, 11-20. doi:10.1016/0002-9343(71)90319-6

[7]   Oh, J.K., Seward, J.B. and Tajik, A.J. (1999) The Echo Manual, 2th Edition, Lippincott Williams & Wilkins, Philadelphia.

[8]   Mugge, A., Daniel, W.G., Haverich, A. and Lichtlen, P.R., (1991) Diagnosis of noninfective mass lesions by two-dimensional echocardiography: comparison of the trasthoracic and transesophageal approaches. Circulation, 83, 70-78.

[9]   Farfel, Z., Shechter, M., Vered, Z., Rath, S., Goor, D. and Gafni, J. (1987) Review of echocardiographically diagnosed right heart entrapment of pulmonary emboli-in- transit with emphasis on management. American Heart Journal, 113, 171-178. doi:10.1016/0002-8703(87)90026-3

[10]   Ehrich, D.A., Widmann, J.J., Berger, R.L. and Abelmann, W.H. (1975) Intracavitary cardiac extension of Hepatoma. The Annals of Thoracic Surgery, 19, 206-211. doi:10.1016/S0003-4975(10)64004-0

[11]   Masaki, N., Hayashi, S., Maruyama, T., Okabe, H., Matsukawa, M., Unno, J., et al., (1994) Marked clinical improvement in patients with hepatocellular carcinoma by surgical removal of extended tumor mass in right atrium and pulmonary arteries. Cancer Chemotherapy and Pharmacology, 33, suppl 1, 7-11. doi:10.1007/BF00686660

[12]   Fujisaki, M., Kurihara, E., Kikuchi, K., Nishikawa, K. and Uematsu, Y. (1991) Hepatocellular carcinoma with tumor thrombus extending into the right atrium: report of a successful resection with the use of cardiopulmonary bypass. Surgery, 109, 214-219.

 
 
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