Renal cell carcinoma masquerading as acute exacerbation of right-sided heart failure: a case report

Renal cell carcinoma is the most common malignancy involving the kidney. This cancer has a propensity for extensive invasion and metastatic spread. Tumor thrombus invasion into the inferior vena cava or renal vein occurs in less than 15% of patients with late stage renal cell carcinoma. Further extension up the inferior vena cava into the chambers of the heart is exceedingly rare, documented in less than 1% of all cases.

Here, we report a case of renal cell carcinoma presenting with what appeared to be an acute exacerbation of right-sided congestive heart failure and fluid overload in a 59-year-old African American male patient. Subsequent imaging revealed the presence of a primary renal cell carcinoma, diffuse metastatic lesions, and intravascular tumor thrombus extension from the inferior vena cava into the right atrium.

This case highlights the diagnostic challenges of RCC due to its diverse metastatic potential and propensity for multisystem complications. Furthermore, it emphasizes the importance of considering a broad range of possibilities in the clinical context of suspected occult malignancy.