PT - JOURNAL ARTICLE AU - Siddhartha Mengi AU - Lyndsey Phelps AU - Tiago Silva Carvalho da Silva AU - Andrew Ludman TI - Clinical examination remains crucial to the correct diagnosis: a case of severe peripheral oedema referred for investigation of heart failure AID - 10.1136/bcr-2018-228322 DP - 2019 Jul 01 TA - BMJ Case Reports PG - e228322 VI - 12 IP - 7 4099 - http://casereports.bmj.com/content/12/7/e228322.short 4100 - http://casereports.bmj.com/content/12/7/e228322.full SO - BMJ Case Reports2019 Jul 01; 12 AB - 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.