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Clinical examination remains crucial to the correct diagnosis: a case of severe peripheral oedema referred for investigation of heart failure
  1. Siddhartha Mengi1,
  2. Lyndsey Phelps2,
  3. Tiago Silva Carvalho da Silva2 and
  4. Andrew Ludman2
  1. 1 Cardiology, Royal Cornwall Hospital, Truro, UK
  2. 2 Cardiology, Royal Devon and Exeter Hospital, Exeter, UK
  1. Correspondence to Dr Siddhartha Mengi, s.mengi{at}


Hepatocellular carcinoma (HCC) uncommonly metastasises to the heart. We present a case of new onset bilateral leg swelling and suspected right heart failure in a previously fit and healthy man, which on further investigation revealed a new diagnosis of HCC with extension into the inferior vena cava and right atrium. This case highlights the importance of considering alternative possibilities when physical examination does not match the initial clinical diagnosis. The management approach was for best supportive care in view of extensive metastatic disease.

  • cardiovascular medicine
  • heart failure
  • liver disease
  • hepatic cancer
  • general practice / family medicine

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  • Contributor SM and AL were responsible for conception or design of the work. SM, LP and TSCdS collected the data. Echocardiogram was done by TSCdS. SM and LP drafted the article. AL did the critical revision of the article. All authors participated in the patient care, conceived the presented idea, researched the literature and wrote the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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