TY - JOUR T1 - Clinical examination remains crucial to the correct diagnosis: a case of severe peripheral oedema referred for investigation of heart failure JF - BMJ Case Reports JO - BMJ Case Reports DO - 10.1136/bcr-2018-228322 VL - 12 IS - 7 SP - e228322 AU - Siddhartha Mengi AU - Lyndsey Phelps AU - Tiago Silva Carvalho da Silva AU - Andrew Ludman Y1 - 2019/07/01 UR - http://casereports.bmj.com/content/12/7/e228322.abstract N2 - 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. ER -