{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:06:18Z","timestamp":1756339578732,"version":"3.44.0"},"reference-count":18,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2022,2,22]]},"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:p>Heterotaxy syndrome is a rare congenital defect of left-right laterality of major visceral organs, often categorised by the presence of symmetric left or right atrial heart chambers with a single effective ventricle. Known as left or right atrial isomerism, these conditions may present with a distinct pattern of extracardiac anomalies. Heterotaxy is often palliated with the Fontan procedure and is suggested to be subject to similar long-term sequelae of congestive hepatopathy and ischaemia, increasing the risk for hepatocellular carcinoma. Few works document primary, localised hepatocellular carcinoma in patients with heterotaxy syndrome. We present a case of diffuse, multifocal metastatic hepatocellular carcinoma in a young patient with left atrial isomerism and dextrocardia. We also review suggested guidelines of surveillance for liver disease and hepatocellular carcinoma in this patient population.<\/jats:p>","DOI":"10.1136\/bcr-2022-248836","type":"journal-article","created":{"date-parts":[[2022,3,7]],"date-time":"2022-03-07T10:50:54Z","timestamp":1646650254000},"page":"e248836","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Diffuse hepatocellular carcinoma secondary to cardiac cirrhosis in heterotaxy syndrome"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3496-2542","authenticated-orcid":false,"given":"Akash","family":"Mathavan","sequence":"first","affiliation":[{"name":"College of Medicine, University of Florida, Gainesville, Florida, 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