**Introduction/Hypothesis:**
A 74-year-old female with a past medical history significant for localized hepatocellular carcinoma in the right hepatic lobe status post partial hepatectomy in 2018 presented to the emergency department with complaints of significant new dyspnea on exertion. Chest CT revealed a new left brachicephalic thrombus but also a 8 x 5 x 6 cm mass in the RV free wall. She was started on anticoagulation therapy and referred for further evaluation of the mass. Subsequent cardiac MRI showed a mass centered on the basal RV free wall which occupied approximately 50% of the ventricular surface and resulted in significant obstruction of the RVOT. There was no encasement of the RCA. The mass demonstrated slightly low signal on T1, heterogenous T2 hyperintensity, and heterogenous enhancement on both first-pass perfusion and late gadolinium images. Interestingly, its morphology closely resembled that of the primary HCC in the liver on a prior CT exam. There was no evidence of pericardial involvement or lesions elsewhere. After a multidisciplinary discussion with the patient, a decision was made to proceed with a percutaneous catheter-based biopsy, which the patient tolerated well. Pathology confirmed the mass was metastatic HCC. Surgical tumor debulking was then performed with a plan for adjuvant chemoradiation.

**Methods**
None (case report)

**Results**
None (case report)

**Conclusion**
Isolated metastasis of hepatocellular carcinoma in the right ventricle is rarely reported. It is thought this could be associated with hematogenous spread of cancer cells to the myocardium. In most cases, cardiac metastases are instead caused by direct tumor invasion of the inferior vena cava with continuous extension into the right heart. The prognosis for metastatic HCC is poor and a cardiac mass could cause flow obstruction with associated hemodynamic instability. Initial presenting symptoms are non-specific but could include dyspnea and chest pain. CT is important for initial detection of a mass and potential secondary lesions. Cardiac MRI can then further assess the morphology and, in combination with echocardiography, evaluate for flow abnormalities. Surgical debulking may relieve symptoms and improve quality of life. A multidisciplinary approach is extremely helpful in executing the complex therapies required.



Case Report: Isolated Hepatocellular Metastasis to the Right Ventricle