Presentation
Abdominal pains and vomiting for 2 weeks
Patient Data
Normal biventricular systolic function. Echogenic fixed right atrial mass measuring 4.2 x 3.4cm. The tricuspid valve orifice is not obstructed. Trace tricuspid regurgitation. Moderate mitral regurgitation.
The liver demonstrates a heterogenous pattern post contrast with an ill defined heterogenous mass in segment II, III . Segment IVb appears to be involved. The lesion in segment II appears to be infiltrating the IVC extending to the right atrium without a clear cardiac mass.
Gallbladder bile appears dense. CBD is dilated. There is mild perihepatic, pericholecystic, peri-splenic, left perirenal and pelvic fluid.
There is a thrombus within superior mesenteric vein and portal vein. Enlarged porta hepatis and gastric bed nodes seen.
Extensive concentric ascending colon wall thickening with associated luminal narrowing.
Multiple pulmonary nodules seen.
Tumor markers and a liver biopsy were done for this patient.
TUMOR MARKERS: AFP :1000 , Ca 125 :145 , Ca 19-9 :14.9 , CEA :1.5 , vitamin D :44 .
HISTOPATHOLOGY:
MACROSCOPIC DESCRIPTION: Four grey-brown cores of tissues longest measuring 1.5cm in length. All processed.
MICROSCOPIC DESCRIPTION: sections show liver cores involved by malignant glandular tumor. The cells are large with pleomorphic nuclei and many mitoses. The tumor seems to bleed within surrounding hepatocytes.
IMMUNOHISTOCHEMISTRY: Cytokeratin 7 - negative , cytokeratin 20 - positive , Villin - positive , Hepar - negative.
DIAGNOSIS: Poorly differentiated adenocarcinoma.
Case Discussion
CT demonstrates features of colorectal carcinoma with hepatic metastasis and IVC tumor thrombus infiltration extending to the right atrial chamber as seen in echo images.
The differentials for the intracardiac mass based on echo findings include a lipoma or a primary tumor such as myxoma.
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