[Right atrial and ventricular thrombus formation in advanced left-side hypernephroma]

Hypernephromas may give rise to extensive thrombus formation in the inferior vena cava. In a 70-year-old female patient, two-dimensional echocardiography revealed a well-defined mass (2 X 2 cm in dimension) in the right atrium with occlusion of the tricuspid valve and thrombo-embolic material spreading from the inferior vena cava to the right atrium. This finding was confirmed by computed tomography and cavography. Computed tomography of the abdomen detected a large left-sided renal tumour and thrombotic occlusion of the whole vena cava. The patient was not willing to undergo surgery and the masses of thrombo-tumorous material in the right atrium and ventricle spread rapidly. Meanwhile a spontaneous recanalization of the oval foramen occurred. The patient died from massive pulmonary embolism. Only the signs and symptoms of right heart failure with confirmed thrombus formation in the right atrium led to the diagnosis of hypernephroma.