Eur J Cardiothorac Surg 2003;23:1054-1055
© 2003 Elsevier Science NL
Images in cardio-thoracic surgery |
Giant renal cell carcinoma directly invading the heart
Stefano Schenaa*,
Jason Gilleranb,
Allen Chernoffb,
Malek G. Massada
a Division of Cardiothoracic Surgery, University of Illinois Medical Center, Chicago, IL 60612, USA
b Department of Urology, University of Illinois Medical Center, Chicago, IL 60612, USA
Received 20 December 2002;
accepted 25 February 2003.
* Corresponding author. Tel.: +1-312-996-6765; fax: +1-312-996-1214
e-mail: sschena{at}uic.edu
Key Words: Renal cell carcinoma • Tumor thrombus • TEE
A 54-year-old female was referred for evaluation of chronic cough and weight loss. Magnetic resonance imaging (MRI) and computed tomography (CT)-scan of chest and abdomen revealed a 10x12 cm mass in the right kidney (Fig. 1A
) with tumor thrombus extending through the inferior vena cava (IVC, Fig. 1B) into the right atrium, as confirmed by transesophageal echocardiogram (TEE, Fig. 2A
). A radical nephrectomy was performed and the IVC accessed under cardiopulmonary bypass. A floating mass with no myocardial invasion was observed allowing its ‘en-block’ extraction from the IVC (Fig. 2B).
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Fig. 1. (A) CT-scan of the abdomen. The tumor consistently modifies the features and increases the size of the right kidney causing parenchymal distortion with fluid collection (arrow). (B) An MRI of the abdomen shows a mass (M) causing intraluminal invasion of the IVC.
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Fig. 2. (A) Intraoperative TEE: a floating mass (M), with no myocardial invasion, is visible within the right atrium (RA). No protrusion into the right ventricle (RV) is present. (B) Surgical specimen: right atrial portion of the tumoral mass (1), a pedicle invading the IVC (2) and the enlarged right kidney containing the primary tumor (3).
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