CTICasesHepatocellular Carcinoma with Intracardiac Extension and Pulmonary Emboli
Imaging findings
Non-contrast CT chest and abdomen shows a large hepatic mass, dilated hepatic veins, and a low-attenuation filling defect extending from the inferior vena cava (IVC) into the right atrium. Multiple low-attenuation filling defects are also noted in the right lower lobe pulmonary arteries, representing tumor emboli.
Key takeaways
Hepatocellular carcinoma (HCC) is notorious for venous invasion. It can extend directly into the hepatic veins, IVC, and right atrium, forming a massive intracardiac tumor thrombus. Because this thrombus is friable, it can embolize to the pulmonary arteries. On non-contrast CT, tumor thrombus appears as a low-attenuation filling defect that can easily be mistaken for bland thrombus, requiring MRI or contrast-enhanced CT to differentiate.
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