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Hepatocellular carcinoma with metastasis to the inferior cava vein and right atrium, an unusual cause of Budd Chiari Syndrome
Yvonne Tadeo-Jiménez, Guadalupe Zafra-Hernández, Nayeli Ortiz-Olvera
Department of Gastroenterology Hospital de especialidades “Dr. Bernardo Spúlveda”, Centro Médico Nacional Siglo XXI, IMSS
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="para0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Ethical statement</span></p><p id="para0006" class="elsevierStylePara elsevierViewall">The identity of the patients is protected&#46; Consentment was obtained&#46;</p><p id="para0007" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Declaration of interests</span></p><p id="para0008" class="elsevierStylePara elsevierViewall">None</p><p id="para0009" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Funding</span></p><p id="para0010" class="elsevierStylePara elsevierViewall">This research did not receive any specific grant from funding agencies in the public&#44; commercial&#44; or not-for-profit sectors&#46;<elsevierMultimedia ident="fig0001"></elsevierMultimedia></p><p id="para0011" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Figure 1&#58;</span> Triphasic computed tomography&#46; 1&#41; Arterial phase&#58; arterial enhancement stronger than the surrounding liver &#40;wash-in&#41;&#46; 2&#41; Venous phase&#58; hypodensity or hyposignal intensity compared to the surrounding liver &#40;wash-out&#41; in the venous phase&#46;<elsevierMultimedia ident="fig0002"></elsevierMultimedia></p><p id="para0012" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Figure 2&#58;</span> Comparison between echocardiography and tomographic reconstruction</p></span>"
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        "resumen" => "<span id="abss0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0001">Introduction and Objectives</span><p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Hepatocellular carcinoma &#40;HCC&#41; represents 80-85&#37; of primary liver malignancies&#44; ranks fifth in annual incidence of cancer&#44; with an annual risk in patients with cirrhosis due to hepatitis B virus &#40;HBV&#41; of 3-8&#37;&#46; It has a tendency to involve vascular structures in the liver&#44; such as the portal vein &#40;VP&#41; and hepatic veins &#40;VH&#41;&#46; Although HCC involvement of VH is seen less frequently compared to PV&#44; tumor thrombi &#40;TT&#41; have been found to extend into the inferior vena cava &#40;IVC&#41; and right atrium &#40;RA&#41; through the HV&#46; In patients with cardiac metastasis&#44; secondary Budd-Chiari&#44; pulmonary infarction and&#47;or pulmonary metastasis have been documented mainly&#46; A certain number of patients with TT-VH may develop Budd Chiari syndrome &#60;3&#37;&#44; associated with chronic HBV infection&#46;</p></span> <span id="abss0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0002">Materials and Patients</span><p id="spara002" class="elsevierStyleSimplePara elsevierViewall">A 58-year-old male patient with a history of human immunodeficiency virus and HBV coinfection&#44; E antigen negative&#44; with virological response&#46; He presented with intense abdominal pain in the left hypochondrium that radiated in a generalized way to the inguinal region bilaterally&#46; During the evaluation&#44; ultrasonographic data of cirrhosis&#44; ascites&#44; Budd-Chiari syndrome&#44; extensive portal thrombosis and hepatocellular carcinoma are found&#46;</p></span> <span id="abss0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0003">Results</span><p id="spara003" class="elsevierStyleSimplePara elsevierViewall">Angiotomography showing areas of ischemia and necrosis in the left hepatic lobe&#44; with the presence of a heterogeneous lesion measuring 5&#46;2 cm that involves segments II&#44; III&#44; IVA&#44; and IVB with enhancement in the arterial phase&#44; portal vein thrombosis&#44; and middle suprahepatic veins&#46; Left&#44; as well as a cardiac tumor dependent on the right atrium with extension to the ipsilateral ventricle and inferior vena cava&#46; A transthoracic echocardiogram shows the involvement of the right heart cavities&#46; Laboratory findings&#58; Valued for oncology services without being a candidate for any therapy&#46;</p></span> <span id="abss0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0004">Conclusions</span><p id="spara004" class="elsevierStyleSimplePara elsevierViewall">We present a case with symptoms compatible with acute Budd Chiari syndrome with extension to the right atrium and right ventricle secondary to hepatocellular carcinoma&#46; Due to the extension of the tumor&#44; it was not a candidate for surgical therapy&#44; thrombolysis or systemic therapy&#44; presenting with a torpid evolution&#46; Metastasis to the inferior vena cava and right atrium secondary to HCC are uncommon&#46; Imaging studies play an important role in determining the type of lesion and its extension&#46; There are few investigations on treatment since high mortality rates are reported with the performance of lumpectomy combined with thrombectomy&#46; Gaining relevance in the search for therapeutics mainly in tertiary level hospitals and in the scrutiny to rule out HCC and HBV infection in a timely manner&#46;</p></span>"
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ISSN: 16652681
Original language: English
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