Clinical examination remains crucial to the correct diagnosis: a case of severe peripheral oedema referred for investigation of heart failure.

Hepatocellular carcinoma (HCC) uncommonly metastasises to the heart. We present a case of new onset bilateral leg swelling and suspected right heart failure in a previously fit and healthy man, which on further investigation revealed a new diagnosis of HCC with extension into the inferior vena cava and right atrium. This case highlights the importance of considering alternative possibilities when physical examination does not match the initial clinical diagnosis. The management approach was for best supportive care in view of extensive metastatic disease. © BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.