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Asian Cardiovasc Thorac Ann 2007;15:364
© 2007 Asia Publishing EXchange Ltd

IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY

Renal Cell Carcinoma with Right Atrial Extension

Jacques Kpodonu, MD, Robert J Cusimano, MD, Michael A Robinette, MD1

Division of Cardiovascular Surgery
1 Division of Urology, Department of Surgery, Toronto General Hospital, The University of Toronto, Toronto, Canada

For reprint information contact: Jacques Kpodonu, MD Tel: 1 602 266 2200 Fax: 1 602 604 5020 Email: jkpodonu{at}azheart.com, Department of Cardiovascular and Endovascular Surgery, Arizona Heart Hospital and Institute, 2623 N.20th Street, Phoenix, AZ 85006, USA.

A 54-year-old woman was evaluated for pyrexia of unknown origin and inferior vena cava (IVC) syndrome. A CT scan of the abdomen revealed a large right renal mass 15 x 12 cm (Figure 1Go) with tumor extension into the right atrium confirmed by transesophageal echocardiogram (Figure 2Go). A right radical nephrectomy with tumor thrombectomy was carried out using the techniques of cardiopulmonary bypass with hypothermic circulatory arrest. The patient is now asymptomatic and remains well at 1 month with resolution of the IVC syndrome.


Figure 1
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  		Figure 1. CT scan of the abdomen demonstrating a large heterogeneous right renal mass. RK = right kidney.

 

Figure 2
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  		Figure 2. Transesophageal echocardiogram showing renal cell tumor thrombus (white arrow) in right atrium (RA).

 
Very large renal tumors with tumor extension into the IVC (type IV) disease respond poorly to antineoplastic therapy alone (chemotherapy and radiotherapy) as such surgery should be considered. The techniques of cardiopulmonary bypass and circulatory arrest1,2 allow for bulky intravascular thrombus to be extirpated from the IVC in a relatively bloodless field. A 5-year survival of 30–72% and operative mortality of 2–13% are achievable provided tumor can be totally resected.

REFERENCES

  1. Krane RJ, deVere White R, Davis Z, et al. Removal of renal cell carcinoma extending into the right atrium using cardiopulmonary bypass, profound hypothermia and circulatory arrest. J Urol 1984;131:945–7.[Medline]

  2. Stewart JR, Carey JA, McDougal WS, et al. Cavoatrial tumor thrombectomy using cardiopulmonary bypass without circulatory arrest. Ann Thorac Surg 1991;51:717–21.[Abstract]





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