Intraoperative Renal Cell Carcinoma Tumor Embolization to the Right Atrium: Incidental Diagnosis by Transesophageal Echocardiography

Pulmonary tumor embolization from renal cell carcinoma is associated with severe cardiopulmonary morbidity and high perioperative mortality rates. We report the case of a 71-year-old woman who presented with right-sided abdominal pain. Magnetic resonance images revealed a mass originating from the upper pole of the right kidney and extending into the infrahepatic portion of the inferior vena cava. Transesophageal echocardiography was continuously used to monitor the mass during intended radical nephrectomy and tumor resection. When the right kidney was mobilized, intracaval thrombus detached and migrated to the patient's right atrium, causing severe hemodynamic instability. After emergent sternotomy and during the initiation of cardiopulmonary bypass, the mass was no longer echocardiographically detectable in the heart; it was soon removed completely from the left pulmonary artery. The mass was a renal cell carcinoma. We recommend the use of transesophageal echocardiography as an efficient diagnostic tool in the early detection of pulmonary tumor embolization during the resection of renal cell carcinoma that involves the inferior vena cava.

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Surgical Approach for Removal of Renal Cell Carcinoma Extending into the Vena Cava and the Right Atrium

The Journal of Urology ◽

10.1016/s0022-5347(17)56207-2 ◽

1980 ◽

Vol 123 (6) ◽

pp. 947-950 ◽

Cited By ~ 67

Author(s):

Andrew C. Novick ◽

Delos M. Cosgrove

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Surgical Approach ◽

Right Atrium ◽

Renal Cell ◽

Vena Cava ◽

The Right

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Renal cell carcinoma with vena caval tumor thrombus extending into the right atrium

Chinese Medical Journal ◽

10.1097/00029330-200611020-00015 ◽

2006 ◽

Vol 119 (22) ◽

pp. 1934-1936 ◽

Cited By ~ 3

Author(s):

Hai JIANG ◽

Zhi-gen ZHANG ◽

Zhao-dian CHEN ◽

Shi-fang SHI ◽

Song-liang CAI ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Right Atrium ◽

Renal Cell ◽

Tumor Thrombus ◽

The Right ◽

Caval Tumor Thrombus

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The importance of intraoperative transoesophageal monitoring when operating on renal cancers that involve the right atrium

Annals of The Royal College of Surgeons of England ◽

10.1308/003588414x13946184903207 ◽

2014 ◽

Vol 96 (6) ◽

pp. e18-e19 ◽

Cited By ~ 2

Author(s):

J George ◽

K Grebenik ◽

N Patel ◽

D Cranston ◽

S Westaby

Keyword(s):

Renal Cell Carcinoma ◽

Surgical Treatment ◽

Cell Carcinoma ◽

Right Atrium ◽

Renal Cell ◽

Transoesophageal Echocardiography ◽

Cardiac Monitoring ◽

Vascular Involvement ◽

Tumour Thrombus ◽

The Right

The surgical treatment of advanced renal cancers is challenging. Renal cell carcinoma is interesting in that it invades the vasculature and can extend up as far as the right atrium. Extension of tumour thrombus into the right atrium represents level IV disease, according to Robson staging. Transoesophageal echocardiography is useful for diagnostic purposes. It is also of great value for intraoperative cardiac monitoring and to confirm the extent of vascular involvement.

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Role of Transesophageal Echocardiography in Detection of Residual Tumor in Renal Cell Carcinoma Extending into Right Atrium

Journal of Perioperative Echocardiography ◽

10.5005/jp-journals-10034-1034 ◽

2015 ◽

Vol 3 (1) ◽

pp. 35-38

Author(s):

Sethu Madhavan, ◽

Ravi Mohan

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Transesophageal Echocardiography ◽

Right Atrium ◽

Renal Cell ◽

Vena Cava ◽

Residual Tumor ◽

Cardiac Complications ◽

Accurate Identification

ABSTRACT Renal cell carcinoma (RCC) has a tendency to invade inferior vena cava and thereby reach the right heart. This may necessitate a combined surgical procedure. These procedures impose a challenge to the anesthesiologist and may require the use of veno-venous or cardiopulmonary bypass (CPB). Among the serious and feared complication is embolization of the thrombus during mobilization of the tumor causing a massive pulmonary embolism. Transesophageal echocardiography (TEE) not only provide accurate identification and definition of the cranial extent of the tumor, but may also provide continuous monitoring of the hemodynamic status and cardiac complications during surgical manipulation of tumor. In this case report, we have described TEE helped in recognizing not only the extent of the tumor but also (the adequacy of removal of the tumor thrombus) diagnose the residual tumor after removal during right radical nephrectomy. How to cite this article Negi SL, Dutta V, Puri GD, Madhavan S, Mohan R. Role of Transesophageal Echocardiography in Detection of Residual Thrombus in Renal Cell Carcinoma extending into Right Atrium. J Perioper Echocardiogr 2015;3(1):35-38.

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