A Shocking Case of Tumor in Transit
Document Type
Conference Proceeding
Publication Date
4-1-2025
Publication Title
Journal of the American College of Cardiology
Abstract
Background: Abdominal malignancies are often associated with venous spread and subsequent embolism. Case: A 74-year-old male with a history of cirrhosis and hepatocellular carcinoma (HCC) in remission presented to the emergency department with chest pain and hypotension. EKG showed no ischemic changes. High-sensitivity troponin and brain natriuretic peptide were normal. CTA of the chest showed bilateral subsegmental pulmonary embolism without signs of right heart strain and a stable lesion in the left hepatic lobe. Transthoracic echocardiogram demonstrated a mobile density in the right atrium, which was confirmed to be occluding most of the inferior vena cava on transesophageal echocardiogram (TEE). Decision-making: After a multidisciplinary discussion, the patient was brought to the cath lab for thrombectomy under TEE guidance. 60- 70% of the mass was successfully removed. Grossly the material appeared to be a mix of tissue and clot suspicious for malignancy. Tissue pathology later confirmed HCC. Despite normal cardiac biomarkers, high clinical suspicion in a patient with hypotension led to further investigation with an echocardiogram, revealing the diagnosis and subsequent appropriate management. Intraoperative imaging was vital for device alignment and real-time evaluation of hemodynamic changes. Conclusion: This case highlights a rare cause of mass in transit from metastatic hepatocellular carcinoma causing obstructive shock successfully managed by percutaneous aspiration.
Volume
85
Issue
12 Suppl
First Page
3435
Last Page
3435
Recommended Citation
Bonkowski T, Bangash N, Huda AS, Saco RZ, Hassouna B. A shocking case of tumor in transit. J Am Coll Cardiol. 2025 Apr 1;85(12 Suppl):3435. doi:10.1016/S0735-1097(25)03919-1
DOI
10.1016/S0735-1097(25)03919-1
Comments
American College of Cardiology (ACC) Meeting, March 29-31, 2025, Chicago, IL