A rare but fatal outcome is hepatocellular carcinoma (HCC) progressing to the right atrial tumor thrombus and inferior vena cava

Hepatocellular carcinoma (HCC) frequently presents with vascular invasion; however, extension of tumor thrombus into the right atrium via the inferior vena cava (IVC) is rare and associated with a poor prognosis. A 48-year-old man presented with progressive dyspnea on minimal exertion. Imaging studies, including transthoracic echocardiography and contrast-enhanced computed tomography, revealed a large hepatic mass with tumor thrombus extending through the hepatic veins and inferior vena cava (IVC) into the right atrium. Due to advanced liver disease and poor performance status, surgical and interventional therapies were not feasible. The patient received supportive treatment including anticoagulation with low molecular weight heparin. Despite treatment, his clinical condition rapidly deteriorated, leading to death shortly after diagnosis. This case highlights the importance of multimodal imaging in identifying intracardiac extension of Hepatocellular carcinoma (HCC) and underscores its grave prognosis.