The purpose of this case study is to describe a patient who presented postnephrectomy with recurrent renal cell carcinoma extending through the inferior vena cava (IVC) into the heart. The metastases were found by transesophageal echocardiography after the patient began retaining fluid in both lower extremities. The IVC portion of the tumor was continuous with the muscular wall, eliminating surgery as an option. Because this tumor has the potential to spread from the renals through the IVC to the heart, it is important for all sonographers, regardless of specialty, to be familiar with it.
Jemal A, Thomas A, Murray T, Thun M: Cancer statistics, 2002. CA Cancer J Clin2002;52:2347-2347.
2.
Devesa SS, Silverman DT, McLauglin JK, Brown CC, Connelly RR, Fraumeni JF: Comparison of the descriptive epidemiology of urinary tract cancers. Cancer Causes Control1990;1(2):133–141.
3.
Konnak JW, Grossman HB: Renal cell carcinoma as an incidental finding. J Urol1985;134:1094–1096.
4.
Tsui KH, Shvarts O, Smith RB, Figlin R, deKernion JB, Belldegrun A: Renal cell carcinoma: prognostic significance of incidentally detected tumors. J Urol2000;163:426–430.
5.
Skinner DG, Pfister RF, Colvin R: Extension of renal cell carcinoma into the vena cava: the rationale for aggressive surgical management. J Urol1972;107:711–716.
6.
Swierzewski DJ, Swierzewski MJ, Libertino JA: Radical nephrectomy in patients with renal cell carcinoma with venous, vena caval, and atrial extension. Am J Surg1994;168:205–209.
7.
Guinan P, Sobin LH, Algaba F, et al: TNM staging of renal cell carcinoma: Workgroup No. 3 Union International Contre le Cancer (UICC) and the American Joint Committee of Cancer (AJCC). Cancer1997;80:992–993.
8.
Motzer RJ, Bander NH, Nanus DM: Medical progress: renal cell carcinoma. N Engl J Med1996;335:865–875.
Kern WF, Silva FG, Laszik ZG, et al: Atlas of Renal Pathology. Philadelphia, PA, W. B. Saunders, 1999.
11.
Pandha H: Medical oncology (II). Integrative Cancer Therapies2004;3(1):29–34.
12.
Belis JA, Levinson ME, Pae WE Jr: Complete radical nephrectomy and vena caval thrombectomy during circulatory arrest. J Urol2000;163:434–436.
13.
Glazer AA, Novick AC: Long-term follow-up after surgical treatment for renal cell carcinoma extending into the right atrium. J Urol1996;155:448–450.
14.
Almassi GH: Surgery for tumors with cavoatrial extension. Semin Thorac Cardivasc Surg2000;12:111–118.
15.
Zanardo G, Michielon P, Paccagnella A, et al: Acute renal failure in the patient undergoing cardiac operation: prevalence, mortality rate, and main risk factors. J Thoracic Cardiovasc Surg1994;107:1489–1495.
