An 82-year-old man presented to the emergency department of the King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia, in 2013 with jaundice, bilateral lower limb oedema and dyspnoea. His laboratory test results were normal, except for elevated α-fetoprotein levels (258.3 ug/L). An ultrasound showed a right hepatic lobe hepatocellular carcinoma (HCC) in segments 6 and 7 of the liver, with tumour extension into the inferior vena cava (IVC) and a right atrial mass lesion. The heart is affected in up to 20% of metastatic HCC cases.1 Although HCC has a tendency to spread into the venous system, intracardiac involvement is extremely rare and has a very poor prognosis.2 Metas-tasis to the heart can occur via the blood stream, the lymphatic system or direct invasion through the IVC to the right atrium, with the latter occurring in 6.5–44% of HCC patients.3,4 Such patients often exhibit symptoms of heart failure due to flow obstruction or a thromboembolism.4,5 Survival usually does not exceed four months, regardless of the type of treatment offered.