Isolated metastasis of hepatocellular carcinoma in the right atrium: a case observed in a university hospital in West Africa (Bouake, Ivory Coast)

Intracardiac metastases from hepatocellular carcinoma (HCC) are rare and have a poor prognosis. We report an observation in a West African university hospital in a 39-year-old black patient admitted with upper gastrointestinal bleeding. Clinical examination noted signs of cirrhosis, namely hepatocellular failure, portal hypertension, melena and signs of right heart failure against a background of deterioration in general condition (WHO-3). The CT scan showed a focal hepatic lesion with arterial enhancement and portal lavage compatible with HCC and a right intracardiac mass taking contrast. Doppler echocardiography confirmed the presence of a large heterogeneous mass occupying almost the entire right atrium. Palliative and symptomatic treatment was instituted in the patient improving his clinical condition. His death occurred two months after his release. The intracardiac localization of HCC, although rare, is not exceptional and of appalling prognosis. It should be sought in the assessment of the extension of HCC, especially in the presence of signs of cardiac involvement.