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30 June 2019 : Case report  Japan

Intracardiac Thrombosis and Heart Failure in a Patient with Hepatocellular Carcinoma and Cardiac Amyloidosis and an Implanted Cardiac Resynchronization Therapy Device

Rare coexistence of disease or pathology

Yasushi Akutsu12ABCDEF*, Mitsuharu Kawamura1D, Hiroki Tanisawa1B, Kosuke Nomura1B, Toshihiko Gokan1B, Teruo Sekimoto1C, Kyoichi Kaneko1D, Yusuke Kodama1D, Yoshimitsu Ohgiya3F, Takaaki Matsuyama4CD, Takehiko Gokan3EF, Toshiro Shinke1A

DOI: 10.12659/AJCR.916672

Am J Case Rep 2019; 20:933-936


BACKGROUND: Intracardiac thrombosis has been known to be associated with not only hepatocellular carcinoma but also with amyloidosis and use of a cardiac implantable electronic device. We report a case of a continuous tumor thrombus with hepatocellular carcinoma from the portal vein and hepatic vein to the right atrium via the inferior vena cava in a patient with a cardiac amyloidosis and an implanted cardiac resynchronization therapy (CRT) device.

CASE REPORT: A 68-year-old female first admitted to our hospital because of heart failure with an AL type primary cardiac amyloidosis. After 3 years, she underwent an implantation of a CRT device for biventricular pacing following repeated episodes of heart failure and low left ventricular ejection fraction of 34% with NYHA class III. Again, she presented with symptoms of heart failure and cardiomegaly on chest x-ray at 7 years after the CRT device implantation. The echocardiography showed a huge echogenic mass occupying the right atrium, and 64 multi-detector computed tomography showed a lobulated heterogeneously enhancing mass of hepatocellular carcinoma in the right upper lobe of her liver and a continuous tumor thrombus from the portal vein and hepatic vein to the right atrium via the inferior vena cava.

CONCLUSIONS: Intracardiac thrombosis and heart failure occurred in a patient with hepatocellular carcinoma and cardiac amyloidosis, who had an implanted CRT device, which resulted not only in hypercoagulability by the hepatocellular carcinoma itself and the accumulation of various risk factors, but also the progression of myocardial damage with the development of amyloidosis.

Keywords: Amyloidosis, Carcinoma, Hepatocellular, cardiac resynchronization therapy, thromboembolism, Cardiac Resynchronization Therapy Devices, Echocardiography, Liver Neoplasms, Risk Factors, Thrombophilia, Thrombosis, Tomography, X-Ray Computed

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923