ArticleInternational journal of surgery case reports2025
Surgical management of renal cell carcinoma with extension into the inferior vena cava and right atrium: A case report.
Article in International journal of surgery case reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Metastatic heart tumors are more prevalent than primary cardiac tumors. Renal cell carcinoma (RCC) is one of the tumor that can spread to the Inferior Vena Cava (IVC) to the right heart chamber. We present the Case of RCC with extension into the IVC and Right Atrium with surgical treatment and approach. Case description: 40-years old male experienced shortness of breath 3 months prior. PET CT-scan showed Lobulated hypermetabolic mass with malignant aspect measuring ±68.6 × 64.9 mm with necrotic area in the right renal lower pole corresponds to RCC. Tumor thrombus (TT) of the inferior vena cava reaches the right atrium. Transthoracic echocardiography showed multiple lobe thrombus from the IVC entering the RA. Surgical therapy with excision of right kidney tumor and TT into the IVC and RA with cardiopulmonary bypass (CPB). Clinical decision: The thrombus was Mayo grade 4, preoperative imaging and intraoperative findings confirmed a short, mobile, non-adherent thrombus without caval wall invasion. Complete removal was achieved with CPB alone, omitting DHCA. Intraoperative transoesophageal echocardiography guided safe extraction, reducing procedural complexity and avoiding DHCA-related risks. Conclusion: Management of RCC with RA extension requires precise assessment of thrombus level, morphology, and metastatic status. In selected Mayo grade 4 cases without wall adhesion, friable thrombus, or valve involvement, CPB without DHCA is a safe alternative, minimizing perioperative morbidity. DHCA should be prioritized when adhesion, friability, or valve extension is present.
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