Pulmonary embolism caused by hepatocellular carcinoma with tumor thrombus extending from hepatic veins into the inferior vena cava and right atrium.

A 63-year-old man presented to emergency department with a 2-hour history of chest tightness and suffocation. The oxygen saturation was 50% while he was breathing ambient air. Laboratory evaluation revealed D2 polymer level, 0.69 mg/L (reference range, 0 to 0.50), activated partial thromboplastin time, 75.0 s (reference range, 28.0 to 43.5). Computed tomography angiography of the chest showed thrombus in the right pulmonary artery, inferior vena cava and right atrium. Coronal view also demonstrated a hepatic mass with a massive neovascularization, extending from hepatic veins into the inferior vena cava.