Medicina, Vol. 58 No. 2, 2022.
Studija slučaja
https://doi.org/10.21860/medflum2022_275138
The extension of hepatocellular carcinoma into the inferior vena cava and right atrium: a case report
Nikolina Morić
; Sveučilište u Rijeci, Medicinski fakultet, Rijeka, Hrvatska
Brankica Mijandrušić-Sinčić
; Sveučilište u Rijeci, Medicinski fakultet, Katedra za internu medicinu, Rijeka, Hrvatska
Sandra Milić
; Sveučilište u Rijeci, Medicinski fakultet, Katedra za internu medicinu, Rijeka, Hrvatska
Dora Fučkar Čupić
; Sveučilište u Rijeci, Medicinski fakultet, Katedra za opću patologiju i patološku anatomiju, Rijeka, Hrvatska
Zrinka Matana Kaštelan
; Sveučilište u Rijeci, Medicinski fakultet, Katedra za radiologiju, Rijeka, Hrvatska
Damir Miletić
; Sveučilište u Rijeci, Medicinski fakultet, Katedra za radiologiju, Rijeka, Hrvatska
Sažetak
Aim: To report a case of a patient with hepatocellular carcinoma that directly invaded the right atrium, initially manifested with painless jaundice and cardiac insufficiency. Case report: A seventy-seven-year-old patient was admitted to the Department of Gastroenterology due to painless jaundice and cardiac insufficiency. Edema of both lower legs and thighs and hepatomegaly were observed in the physical status. Laboratory analysis revealed elevated serum creatinine, total bilirubin, liver enzymes and prolonged prothrombin time and activated partial thromboplastin time. Radiographic tomography showed no pathological finding. In further procedure, abdominal ultrasound was performed which revealed the enlarged liver with irregular surface, diffusely hyperechoic, inhomogeneous, without visible focal lesions with dilation of the intrahepatic bile ducts The test for hepatitis B and C markers were negative. To clarify the cause of biliary obstruction, abdominal magnetic resonance imaging and magnetic resonance cholangiopancreatography (MRCP) were indicated. An infiltrative tumor was detected that extensively affected the bile ducts, invaded the inferior vena cava, and penetrates directly into the right atrium. Hepatocellular carcinoma (HCC) was confirmed by core needle biopsy and histopathological examination. During hospitalization, cardiac therapy, low molecular weight heparin, albumin substitution, and antibiotic therapy for Clostridium difficile infection were prescribed. Despite the efforts and treatment, the patient passed away because of multiple organ failure. Conclusion: The extension of hepatocellular carcinoma per continuitatem into the right atrium is a rare entity. In the case of painless jaundice and negative ultrasound findings, it is necessary to extend the imaging diagnostics to magnetic resonance imaging and MRCP which is superior in the assessment of the biliary tree. Although jaundice is a rare manifestation of hepatocellular carcinoma, this entity should not be ruled out, especially in patients with liver cirrhosis.
Ključne riječi
biopsy; carcinoma, hepatocellular; heart atria; magnetic resonance imaging
Hrčak ID:
275138
URI
Datum izdavanja:
1.6.2022.
Posjeta: 1.024 *