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This is a case report of a 54-year-old patient with hepatocellular cancer under palliative chemotherapy who admitted with dyspnea on minimal exertion and peripheral oedema over the past 5 days. Echocardiogram revealed a large echogenic mass in the right atrial cavity which did not enhance with intravenous echo contrast agent, and a distended inferior vena cava (IVC) which was occluded by echogenic material with no signs of flow. To distinguish with accuracy if the thrombus was a bland or tumor thrombus, contrast-enhanced Computed Tomography (CT) was performed. CT Pulmonary Angiography and abdominal contrast-enhanced CT showed a distended and occluded IVC by a mass that extended to the right atrium and enhanced with intravenous contrast agent, and thus the mass was considered as a tumor thrombus. Due to the impaired performance status and liver function of the patient, supportive treatment was preferred instead of a surgical or radiological intervention. Large tumor thrombus extending into the right atrium through the inferior vena cava due to hepatocellular carcinoma has a rare incidence and is associated with a poor prognosis.