A Case of Hepatocellular Carcinoma with Intra-atrial Tumor Thrombus Presenting Pulmonary Thromboemboli

Takanori Kyokane, Shinsuke Iyomasa, Naoki Sawasaki, Yuichiro Tojima, Hidenari Goto, Hiroyuki Watanabe, Takehiro Takagi and Masao Matsuda

Department of Surgery, Chukyo Hospital

We report an extremely rare case of hepatocellular carcinoma (HCC) presenting as pulmonary thromboembolism. A 64-year-old woman followed up for a 15 mm HCC tumor and admitted for sudden dyspnea onset was found in computed tomography to have a pulmonary thromboembolism in the right pulmonary artery and tumor thrombus (TT) extending into the right atrium. Following successful thrombolytic therapy, we conducted right hepatectomy with TT removal by total hepatic vascular exclusion (THVE). Active venovenous bypass was necessary because of low blood pressure during THVE. The resected specimen showed a 22×16 mm HCC tumor at hepatic S7, and a 5.0×2.5 cm extrahepatic TT extending into the right atrium. Her postoperative course was without complications. The woman was doing well without recurrence 12 months after surgery when multiple pulmonary metastases were noted. She remains alive 2 years after surgery with good quality of life. To the best of our knowledge, this is the first case of HCC reported with intracaval or intraatrial TT presenting with pulmonary thromboembolism as the primary manifestation.

Key words
hepatocellular carcinoma, intraatrial tumor thrombus, pulmonary embolism

Reprint requests
Takanori Kyokane Department of Surgery, Fukuroi Municipal Hospital
2515-1 Kunou, Fukuroi, 437-0061 JAPAN

Accepted
September 16, 2009

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