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(Circulation. 1997;96:2729-2730.)
© 1997 American Heart Association, Inc.

Articles

Renal Cell Carcinoma With Tumor Thrombus Extending Through the Inferior Vena Cava Into the Right Cardiac Cavities

Tushar Chatterjee, MD; Markus F. Muller, MD; Thierry Carrel, MD; Urs Kaufmann, MD; ; Bernhard Meier, MD

From the Department of Cardiology, University Hospital Bern, Switzerland.

Correspondence to Tushar Chatterjee, MD, Department of Cardiology, University Hospital Bern, Inselspital, Freiburgstrasse 4, Switzerland.

	Introduction

 
A 44-year-old white female patient was admitted to the hospital with signs of congestive heart failure. The patient had no history of cardiac disease. She had been in good health until 6 months earlier, when she noted exertional dyspnea, swollen legs, and easy fatigue. The ECG showed sinus rhythm with normal axis and some ventricular premature beats. There was a localized right pleural effusion with normal cardiac silhouette on chest roentgenogram. Transthoracic echocardiography and cine MRI demonstrated a large tumor within the right atrium protruding into the right ventricle through the tricuspid valve during diastole (Figs 1 and 2). A Doppler study showed accelerating flow in the right atrium outflow tract during diastole, indicating partial flow obstruction. By means of echocardiography and cine MRI, the tumor could be followed down the inferior vena cava to the left kidney (Figs 3 and 4). Successful complete surgical tumor removal was performed on cardiopulmonary bypass to allow intracardiac exploration and prevent tumor embolization into the lung (Fig 5A and B).

View larger version (50K): [in this window] [in a new window]   Figure 1. Apical four-chamber, two-dimensional transthoracic echocardiogram showing a large, homogenous, round, echogenic tumor in diastole (A) and systole (B). The tumor resides in the right atrium in systole and prolapses through the tricuspid valve into the right ventricle during diastole.

View larger version (149K): [in this window] [in a new window]   Figure 2. Four axial, contrast-enhanced, T1-weighted, gradient echo images (flip angle/repetition time/time to echo=40/40/7 ms) from a segmented cine sequence obtained 40 (top left), 80 (top right), 120 (bottom left), and 240 (bottom right) ms after the R wave, respectively. . . . [Full Text of this Article]

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