Una non comune complicanza dell’epatocarcinoma: trombosi portale e cavale inferiore con estensione fino all’atrio destro. Descrizione di un caso clinico

A 72 years old woman with hepatocellular carcinoma and HCV related cirrhosis, treated with Thalidomide for seven months, presented with dyspnoea and ascites. The patient was treated with large volume paracentesis and the dose of diuretics was increased obtaining reduction of the ascetic fluid. The white cells count on ascites was diagnostic for spontaneous bacterial peritonitis and the patient was treated with antibiotics. The abdominal ultrasound showed portal vein thrombosis with inferior vena cava invasion. Because of that, an echocardiogram was performed which showed right atrium thrombotic invasion. As a result of the fragile conditions of our patient, we couldn’t perform a cardiac biopsy, so we proceeded to a contrast enhancement US that showed the neoplastic origin of inferior vena cava and right atrium thrombosis. Because of the failing hemodynamic status and impaired liver function, the patient didn’t undergo any invasive treatment. She was treated with medical therapy and passed away six months later. This case higlights the importance of early diagnosis of thrombosis in patients with hepatocellular carcinoma. Only an early diagnosis permits to manage the disease with more aggressive therapy, that is impossible in the advanced status of liver disease.