Pulmonary embolism in renal cell carcinoma with vena cava extension

Of 18 patients with renal cell carcinoma extending into the inferior caval vein, 11 underwent nephrectomy and cavathrombectomy and were examined by pulmonary scintigraphy pre- and postoperatively. In 7 patients, who underwent non-radical surgery or no surgery at all and had died of generalized tumour, the postmortem examination reports were scrutinised. On pulmonary scintigraphy, altogether 6 patients (55%) were free from perfusion defects preoperatively. Between the pre- and postoperative examination, perfusion defects appeared, disappeared, varied in size or were unchanged. Only 4 patients (36%) had acquired new defects. The total number of defects preoperatively was 14 and postoperatively 12. Most defects engaged less than a pulmonary segment and only 2 a whole segment. None gave clinical symptoms. No macroscopic pulmonary emboli were found in any patient at the postmortem examination.