P4771 - Hepatocellular Carcinoma Causing Cardiac Compression

Shawn Philip, DO, Nazir Ahmed, MD, Colin Westman, DO, Jonathan Weinberger, MD
Hackensack University Medical Center, Hackensack, NJ

Introduction: Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world with 80% of patients diagnosed having underlying cirrhosis. We present a case of a cirrhotic patient with an atypical presentation of HCC causing mass effect and further cardiac decompensation.

Case Description/Methods: An 81 year old female with history of decompensated NASH cirrhosis, Type II Diabetes Mellitus, Hypertension, and Dementia was referred from a nursing home for hypotension. Her Decompensated cirrhosis was manifested by the presence of Esophageal Varices, Altered Mental Status, and Abdominal Ascites. Her vitals on presentation were significant for blood pressure 94/45, heart rate 102 and temperature 95.6 F. On examination, she was noted to be in altered mental status with scleral icterus and diffuse abdominal tenderness. Her pertinent labs include hemoglobin 8.2 alanine aminotransferase 60, aspartate aminotransferase 16, alkaline phosphatase 245, total bilirubin 6.3 (direct 3.3), INR 1.53, albumin 2.1 and ammonia 28. Initial CT abdomen without contrast revealed a cirrhotic liver with new 13.4 x 10.4 cm mass in the right hepatic lobe suggestive of hepatocellular carcinoma with an enlarged possible metastatic thoracic node. The right perihepatic space contained a 12.9 x 2.3 cm fluid collection concerning for hemorrhage. Her subsequent CT angiogram showed hyperdense material suggestive of blood without active extravasation and showed the hepatic mass extending into right and left hepatic lobes. There was an extensive mass effect of the heart with compression of the right atrium. Her Alpha Fetoprotein (AFP) level was elevated to >300,000 ng/mL.



Further aggressive interventions for the mass were not pursued after the family opted for hospice care.

Discussion: HCC surveillance is recommended for all cirrhotic patients with Child Pugh A, B and also Child Pugh C awaiting transplant. We describe a patient with h/o Child Pugh B cirrhosis, with normal AFP and no mass on previous imaging 2 years ago now presenting with probable metastatic HCC. Her presentation was remarkable for a large hepatic mass causing cardiac compression. Although case reports have described cardiac metastasis, right atrium compression by HCC has not been reported to our knowledge previously. This case highlights how HCC can manifest in an atypical presentation in cirrhotic patients and highlights the possibility of liver tumor burden causing cardiopulmonary compromise.


Disclosures:


Shawn Philip, DO, Nazir Ahmed, MD, Colin Westman, DO, Jonathan Weinberger, MD. P4771 - Hepatocellular Carcinoma Causing Cardiac Compression, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.