Metastatic renal cell carcinoma extending to the left atrium through the inferior pulmonary vein

Area of Science:

• Cardiology
• Oncology
• Thoracic Surgery

Background:

• Metastatic renal cell carcinoma (RCC) is a complex malignancy.
• Pulmonary vein and left atrial involvement by metastatic RCC is exceptionally rare.
• Surgical management of thoracic metastases requires careful pre-operative assessment.

Observation:

• A 70-year-old male presented with metastatic renal cell carcinoma.
• The tumor involved the right lower lobe lung mass, abutting the inferior pulmonary vein.
• Tumor extension into the left atrium was identified intraoperatively without prior evidence.

Findings:

• The metastatic lung mass extended through the pulmonary vein into the left atrium.
• Surgical resection was successfully performed via posterolateral thoracotomy.
• Pre-operative imaging failed to detect the intracardiac extension.

Implications:

• Lung masses adjacent to pulmonary veins necessitate thorough pre-operative evaluation.
• Transesophageal echocardiography is recommended for assessing potential vascular and intracardiac invasion.
• This case highlights the importance of advanced imaging in surgical planning for metastatic disease.