tricuspid valve obstruction by a tumour thrombus in primary liver cell carcinoma

An adult male in his early thirties presented with gradual weight loss over several months; during which he became jaundiced and lately insidious breathlessness. On physical examination, he was cachectic with irregular upper abdominal distension. There was no lower limb oedema or other feature of congestive cardiac failure. There was however a hard, knobbly and tender liver on abdominal palpitation; which on abdominal ultrasound was reported as primary liver cell carcinoma (PLCC). Alpha fetoprotein level was also in support of the diagnosis.