TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN THE DETECTION OF INFERIOR VENA-CAVA AND CARDIAC METASTASIS IN HEPATOCELLULAR-CARCINOMA

Antemortem diagnosis of inferior vena cava (IVC) and cardiac metastasi s of hepatocellular carcinoma (HCC) is difficult but important before consideration of curative resection. There are only a few cases of car diac metastasis of HCC which have been diagnosed antemortem by echocar diography. Accordingly, 18 consecutive patients with HCC who were pote ntial candidates for curative resection were studied by transthoracic (TTE) and transesophageal echocardiography (TEE). One (6%) and two (11 %) patients had cardiac and IVC metastasis of HCC, respectively, which was detected by two-dimensional TTE. In contrast, by using TEE, four patients (22%) showed tumor invasion of the IVC, of whom two (11%) had tumor mass extending into the right atrium (RA). There was no signifi cant difference in age, serum level of alpha-fetoprotein, and percenta ge of right liver lobar involvement between those with and without car diac metastasis. Patients without cardiac metastasis detected on TTE o r TEE had significantly longer mean duration of survival (5.0 +/- 2.1 vs. 2.1 +/- 1.0 months; p < 0.05), In summary, TEE may be more useful than TTE in the detection of cardiac metastasis of HCC, which occurred in 22% of patients whose primary tumor was considered to be surgicall y resectable in our series. This can be safely performed in patients w ith HCC and can provide optimal visualization of the IVC and RA. The h igh prevalence of subclinical cardiac metastasis in HCC mandates the u se of TEE in all patients with HCC prior to surgical intervention.