# Cardiac-to-Bronchial Fistula in Hepatocellular Carcinoma: A Case Report

## TL;DR

A case report describes a rare complication in a patient with liver cancer where tumors created abnormal connections between the heart and lungs, causing life-threatening air embolisms.

## Contribution

This report highlights a rare supradiaphragmatic complication in hepatocellular carcinoma patients following treatment.

## Key findings

- A patient with HCC developed tumor-to-bronchial and tumor-to-cardiac fistulas after treatment.
- The fistulas led to massive air emboli in the circulation.
- Post-treatment secondary infections and diaphragmatic defects may predispose to such complications.

## Abstract

Hepatocellular carcinoma (HCC) stands as a significant contributor to cancer-related mortality globally. While the acute and often fatal manifestations of locally advanced HCC primarily present within the abdomen, it is crucial to recognize that the respiratory and circulatory systems can also fall victim due to the liver’s unique anatomical position within the body. Here, we present the case of a 63-year-old male recently diagnosed with locally advanced HCC with vascular invasion. Shortly after receiving target therapy and focal radiotherapy, the patient developed repeated secondary infections and a persistent diaphragmatic defect. As the necrotic tissue invaded the pleural space, subsequent tumor-to-bronchial and tumor-to-cardiac fistulas emerged, resulting in an abnormal connection between the respiratory and cardiovascular systems, leading to massive air emboli in circulation. This report highlights the risk of supradiaphragmatic complications in HCC patients with post-treatment secondary infections, particularly in patients predisposed to developing diaphragmatic defects.