We present a case report of primary hepatocellular carcinoma with tumor thrombus extending into the right atrium complicated by pulmonary embolism. A 49-year-old man was admitted to our hospital for searching a cause of thrombus in the right atrium. The patient complained of shortness of breath and oedema of the lower extremities. He had a history of hepatitis B. Abdominal sonography and computed tomography revealed a tumor of the liver. A needle biopsy confirmed the diagnosis of hepatocellular carcinoma. Magnetic resonance showed a tumor thrombus also in the inferior vena cava. The diagnosis of pulmonary embolism was confirmed by pulmonary perfusion scintigraphy. This case stresses that clinicians should include hepatocellular carcinoma among the possible causes of intracardiac thrombus and pulmonary embolism.

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