Hepatocellular carcinoma is fatal and has a marked propensity for vascular invasion. However, tumor thrombi rarely occur in the right atrium. A 72-year-old man was admitted with dyspnea and disturbed consciousness. Abdominal computed tomography and echocardiography showed a huge tumor thrombus in the inferior vena cava and the right atrium. The tumor thrombus was surgically removed to treat the hemodynamic compromise. The patient underwent transcatheter arterial chemoembolization postoperatively and survived for 6 months.
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