Incidental Detection of Hepatocellular Carcinoma by Echocardiographic Imaging During Acute Coronary Syndrome Evaluation.
Hepatocellular carcinoma is a primary liver malignancy that may invade vascular structures, including the inferior vena cava, in advanced stages. Detection during cardiac imaging is uncommon. A 73-year-old man with hypertension and type 2 diabetes mellitus presented with chest pain suggestive of acute coronary syndrome. Initial electrocardiographic assessment and cardiac biomarkers showed no evidence of myocardial injury. During transthoracic echocardiographic evaluation, an unexpected mass was identified within the inferior vena cava on the subcostal view. Subsequent contrast-enhanced computed tomography demonstrated a large right hepatic lobe mass with characteristic arterial enhancement and portal venous/delayed-phase washout, along with inferior vena cava invasion. Histopathological examination confirmed hepatocellular carcinoma. This case illustrates the importance of a systematic echocardiographic approach, as incidental extracardiac findings may reveal significant underlying disease and alter clinical management.