A 51-year-old man presented with exertional dyspnea for two months. He had a history of hepatocellular carcinoma that was totally resected three years earlier. Radionuclide angiocardiography disclosed a large photopenic area separating the heart from the liver, and lung blood pools mimicking a large pericardial effusion. Echocardiography and magnetic resonance imaging of the heart, however, showed extensive tumor infiltration of the myocardium of both ventricles. Endomyocardial biopsy confirmed the diagnosis of metastatic hepatocellular carcinoma. There was no evidence of recurrent hepatoma in the liver.