Left Ventricular Metastasis from Hepatocellular Carcinoma Presenting With Systemic Embolization and Stroke.

BACKGROUND

Cardiac metastases are more common than primary cardiac tumors but are often unrecognized. Hepatocellular carcinoma (HCC) rarely involves the heart, typically affecting the right atrium. Left ventricular (LV) involvement is extremely rare and may cause systemic embolization.

CASE SUMMARY: A 71-year-old man with prior HCC presented with acute stroke symptoms. Neuroimaging revealed multifocal acute infarcts. Computed tomography revealed a psoas mass and splenic and renal infarcts, raising concern for malignancy-associated embolization. Transthoracic echocardiography identified an LV mass initially suspected as thrombus. Cardiac magnetic resonance imaging (CMR) supported metastatic tumor. Psoas biopsy confirmed recurrent HCC. The patient was started on nivolumab and ipilimumab with planned radiation.

DISCUSSION: HCC can rarely metastasize to the LV and present with systemic embolization. Multimodality imaging, particularly CMR, is critical for diagnosis and management.

TAKE-HOME MESSAGES: LV metastasis from HCC, although rare, may present with systemic embolization. CMR is key to distinguishing tumor from thrombus and guiding management.