Hepatocellular Carcinoma Masquerading as Heart Failure: When POCUS “Incidentally” Detects Cancer

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death worldwide, and cardiovascular involvement can occur in advanced cases. An 84-year-old man with subacute dyspnea on exertion and pedal edema was referred to the cardiologist for suspected heart failure. Point of care ultrasound (POCUS) revealed scant ascites, a liver mass, and inferior vena cava (IVC) tumor thrombus extending into the right atrium. Computed tomography confirmed HCC with extensive intravascular spread and pulmonary emboli. This case illustrates a rare phenomenon of HCC masquerading as heart failure and underscores the potential value and challenges of incorporating POCUS into outpatient evaluations for earlier cancer detection.