PICTURES IN DIGESTIVE PATHOLOGY

 

Debut of an unusual liver cirrhosis

Debut de cirrosis hepática poco habitual

 

 

María Facenda-Lorenzo¹, Sonia Pascual-Pérez², Ana Laynez-Carnicero¹ and Alejandro Quijada-Fumero¹

Services of ¹Cardiology and ²Radiology. Hospital Universitario Nuestra Señora de La Candelaria. Santa Cruz de Tenerife, Spain

 

 

Background

Metastatic cardiac tumors are much more common than primary benign or malignant cardiac tumors. Transthoracic echocardiography (TTE) is the primary diagnostic procedure, followed by computed tomography (CT) and cardiac magnetic resonance imaging (MRI) to analyze other structures (1).

 

Case report

We report the case of an 83-year-old man with chronic hepatitis B with dyspnea and edema in the lower extremities. TTE showed a right dyskinetic ventricle (RV) and a mass in the right atrium (RA). This mass did not prolapse to the RV and the edges were irregular (Fig. 1A and B). The cardiac MRI showed a heterogeneous mass of 60 x 30 mm in the RA from the inferior vena cava (IVC) without collapsed or compromised RV filling, with thrombi attached (Fig. 1C). The CT showed a solid nodule of 13 mm in the lower lobe of the right lung with enhancement after contrast that suggested a metastatic origin and a cirrhotic liver with an undefined heterogeneous mass (37 x 45 x 42 mm) in segment VII. It had a loss of planes with the intrahepatic vena cava and an extension into the right cardiophrenic space. It was echodense compared with the rest of the liver parenchyma, and had peripheral areas of low attenuation values, suggesting a hepatocellular carcinoma. The CT (Fig. 2) also showed a multi-lobulated and heterogeneous mass of 48 x 24 mm in the RA that was extended to the intrahepatic IVC. The alpha-fetoprotein was greater than 2,000 mcg/ml.

 

 

 

Discussion

The most frequent sites of extra hepatic metastasis of hepatocellular carcinoma are the lungs, lymph nodes, adrenal glands and bones. They tend to spread through intrahepatic blood vessels and lymphatics, or by direct infiltration (2). However, intra-cardiac involvement rarely develops (3).

 

References

1. Abad C. Tumores cardiacos (II). Tumores primitivos malignos. Tumores metastásicos. Turmor carcinoide. Rev Esp Cardiol 1998;51(2):103-14. DOI: 10.1016/S0300-8932(98)74719-0.         [ Links ]

2. Albackr HB. A large right atrial mass in a patient with hepatocellular carcinoma: Case report and literature review. J Saudi Heart Assoc 2014;26(3):174-8. DOI: 10.1016/j.jsha.2014.02.002.         [ Links ]

3. Yu K, Liu Y, Wang H, et al. Epidemiological and pathological characteristics of cardiac tumors: A clinical study of 242 cases. Interact Cardiovasc Thorac Surg 2007;6(5):636-9. DOI: 10.1510/icvts.2007.156554.         [ Links ]