Migration of an Inferior Vena Cava Tumor Thrombus during Renal Cell Carcinoma Resection

Author:

Hatzakorzian Roupen12ORCID,Blotsky Andrea23,Moore Albert1,Vaillancourt Julien1,Mettasittigorn Pattra1,Aprikian Armen4,Backman Steven B.1

Affiliation:

1. Department of Anesthesia, McGill University Health Centre, Glen Site, Royal Victoria Hospital, 1001 Boulevard Décarie, Montréal H4A 3J1, Québec, Canada

2. Department of Critical Care, McGill University Health Centre, Glen Site, Royal Victoria Hospital, 1001 Boulevard Décarie, Montréal H4A 3J1, Québec, Canada

3. Department of General Internal Medicine, McGill University, St-Mary’s Hospital, 3830 Lacombe Avenue, Montréal H3T 1M5, Québec, Canada

4. Department of Urology, McGill University Health Centre, Glen Site, Royal Victoria Hospital, 1001 Boulevard Décarie, Montréal H4A 3J1, Québec, Canada

Abstract

Approximately 4%–10% of patients with renal cell carcinoma (RCC) have tumoral vascular invasion with resultant thrombi in the renal vein and in the inferior vena cava (IVC). The authors describe an interesting case of IVC tumor thrombus that migrated to the right cardiac chambers during RCC resection. The diagnosis was made by intraoperative transesophageal echocardiography (TEE), which revealed the presence of a free-floating thrombus between the right atrium (RA) and right ventricle (RV). The patient required an urgent sternotomy with cardiopulmonary bypass (CPB) for atrial thrombus removal prior to the completion of the nephrectomy. The patient made a full recovery and was discharged to a rehabilitation facility. These findings illustrate the importance of intraoperative TEE monitoring during nephrectomy and IVC thrombectomy. In this case, TEE allowed for the diagnosis of an unexpected complication necessitating prompt cardiac surgical management.

Publisher

Hindawi Limited

Subject

Anesthesiology and Pain Medicine

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