Year 2017 / Volume 109 / Number 4
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Hepatocellular carcinoma presenting with Budd-Chiari syndrome, right atrial thrombus and pulmonary emboli

296-297

Luís C. Lourenço, David V. Horta, Sara F. Alberto, Jorge Reis,

Abstract
A 47-year-old patient presented with a two-week history of right upper quadrant pain, abdominal distention and new onset of shortness of breath. He had a history of intravenous drug abuse, no alcohol consumption and denied any known liver disease. On physical examination, he was tachypneic and had dullness in the flanks. His blood analysis at admission was as follows: hemoglobin, 12.9 g/dL; leukocyte count, 6,800/uL; platelet count, 63,000/uL; INR, 2.1; serum creatinine, 1.27 mg/dL; liver biochemistry tests were notable for marginal derangement, HBsAg was negative, anti-HCV was positive, HCV RNA was 367,498 IU/ml and alpha-fetoprotein was 992 mg/dL. Abdominal ultrasound showed a right liver lobe mass (13 cm in diameter) with inferior vena cava (IVC) thrombosis and mild peri-hepatic ascites. A 2D echocardiogram showed a presumed right atrial tumor thrombus. A multiphasic contrast-enhanced abdominal tomography (CT) confirmed a hepatocellular carcinoma (HCC) with IVC obstruction and extensive tumoral thrombus to the right atrium (14 cm long).
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References
1. Horton JD, San Miguel FL, Membreno F et al. Budd-Chiari syndrome: illustrated review of current management. Liver Int 2008;28:455–66.
2. Boutachali S, Arrive L. Budd–Chiari syndrome secondary to hepatocelular carcinoma. Clin Res Hepatol Gastroenterol 2011;35: 693–4.
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Lourenço L, Horta D, Alberto S, Reis J. Hepatocellular carcinoma presenting with Budd-Chiari syndrome, right atrial thrombus and pulmonary emboli. 4487/2016


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Publication history

Received: 05/06/2016

Accepted: 16/09/2016

Published: 31/03/2017

Article revision time: 98 days

Article editing time: 299 days


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