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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.

Vascular toxicity caused by cancer treatment can present as vasospasm, arterial thrombosis, and accelerated atherosclerosis. We report a case of a 60-year-old man with metastatic renal cell carcinoma under cabozantinib treatment for 3 years who presented to the hospital with relapsing episodes of rest angina. Due to the presence of ST depression in the 12-lead electrocardiogram and elevated troponin, a non-ST-segment elevation myocardial infarction was suspected. The patient underwent invasive coronary angiography, which revealed extended coronary artery spasm, and it subsided totally after nitrate administration. One year later, the patient presented again at the cardio-oncology outpatient clinic, reporting relapsing episodes of angina during the previous month. Coronary computed tomography angiography was performed, and it revealed 2 subsequent 70%-99% stenosis in OM1. To our knowledge, this is the first case of a patient treated with cabozantinib presenting with coronary artery spasm and accelerated atherosclerosis, in which a multimodality imaging approach was followed.