Abstract
A 40-year-old man with a medical history of hepatitis B presented with abdominal distention and leg swelling. A computed tomography scan of the abdomen revealed cirrhosis and a large mass extending from the liver into the inferior vena cava and extending into the right atrium. A transthoracic echocardiogram revealed a large right atrial mass extending from the inferior vena cava with possible attachment to the interatrial septum. The patient was eventually determined to have advanced hepatocellular carcinoma with invasion into the inferior vena cava and into the right atrium, along with pulmonary metastases.