Renal Cell Carcinoma With Tumor Thrombus Extending Through the Inferior Vena Cava Into the Right Cardiac Cavities
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).
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
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