Interval Echocardiography of Medically Managed Extensive Intracardiac Renal Cell Tumor Thrombus

Renal cell carcinoma is associated with tumor thrombus that can extend into the inferior vena cava and right atrium, representing risk of massive pulmonary embolism.

A 60-year-old woman was diagnosed with renal cell carcinoma. Computed tomography imaging demonstrated a heterogeneous mass extending from the right renal vein into the right ventricle in keeping with tumor thrombus. On transthoracic echocardiogram, the tumor thrombus can be seen to prolapse into the right ventricle with diastole. Surgical extraction was discussed but ultimately not performed. At 6 weeks post diagnosis, the tumor thrombus had organized and become more homogeneous. At 12 weeks post diagnosis, the patient remained well without signs of thromboembolism.

We present a case of increasing organization and size reduction of medically managed extensive renal cell tumor thrombus on interval echocardiography.

In cases in which surgical extraction is unsuitable, risk of tumor thrombus extension or thromboembolism may reduce with anticoagulation.