Hepatobiliary and Pancreatic: Chest tightness as a manifestation of cardiac metastasis related to hepatoma

Abstract

A 47-year-old male patient was admitted to the hospital due to chest tightness and dyspnea for 3 days, which can be self-relieving after 3–5 min of rest. He had no relevant previous medical history except for arterial hypertension for 5 years and chronic hepatitis type B for 10 years. The laboratory results showed that the liver and kidney function tests were within normal ranges. the creatine kinase (113.6 U/L), creatine kinase isoenzyme-MB (3.40 ng/ mL), troponin I (0.00 mg/mL), and alpha fetoprotein (3.36 ng/ mL) were all normal. Cardiac ultrasound demonstrated a large right atrial mass, 3.5 cm in diameter but not involving the tricuspid valve. Magnetic resonance imaging showed a large hepatic tumor (Fig. 1a, thick arrow) in addition to the right atrial mass (Fig.1a, thin arrow), both with slightly high intensity in the T2-weighted image. A fluoro-18-deoxyglucose positron emission tomography CT (FDG-PET/CT) scan was performed and showed the atrial mass with high FDG uptake (Fig.1b), without other abnormalities on the maximum intensity projection image (Fig.1c). The patient underwent a simultaneous resection of the two tumors under cardiopulmonary bypass. Histologically, the tumors were moderately differentiated hepatocellular carcinoma (HCC). The common metastatic sites of HCC are the lungs, lymph nodes, adrenal glands, and bones. Intracardiac involvement is an unusual form of HCC metastasis, with a reported rate of 1.2%. Various cardiac symptoms such as sudden dyspnea, chest pain, lower extremity edema, and even sudden death can be encountered in HCC patients with intracardiac involvement. Traditionally, it has an extremely poor prognosis regardless of the treatment strategy, with a median survival range of 1–4 months. In our patient, he obtained relatively long-term survival through the simultaneous resection of HCC and intracardiac tumor but eventually succumbed to HCC progression 1 year later. Although cardiac metastasis is rare, our case alerts physicians to pay attention to patients with no obvious cause of chest tightness and dyspnea, especially for those with malignant tumors like HCC.