Cardiac metastasis from a renal cell carcinoma

Renal cell carcinomas are known to extend into the renal vein and inferior vena cava, but cardiac metastases are rare and usually clinically silent. In the case described here, there was evidence of right ventricular outflow obstruction, associated with a metastatic renal tumour in the right ventricular wall protruding into the ventricular cavity. The patient had presented years earlier with an ulnar neuropathy, for which the tumour may have been responsible. This case highlights the need to consider an underlying paraneoplastic syndrome in a patient presenting with neuropathy, because appropriate investigation could have led to early detection and possible cure of the renal lesion. When renal cell carcinoma is confined to the renal parenchyma, five-year survival is up to 70%, but this falls to 5% in the presence of distant metastases.