Intracaval invasion of left adrenal cortical carcinoma extending into the right atrium

A case of adrenal carcinoma with advanced inferior vena cava (IVC) involvement is reported. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a large mass over the upper pole of the left kidney, with tumor thrombus from the IVC to the right atrium of the heart. Angiography demonstrated that this mass received its blood supply mainly from the left superior adrenal artery, and, parasitically, the left middle adrenal artery, splenic artery, and lumbar arteries. Venacavography revealed obstruction of the IVC and the collateral, dilated azygos vein. Radical surgery was performed, including resection of the tumor and the tumor thrombus in the IVC and right atrium with the aid of cardiopulmonary bypass. Although renal carcinoma with tumor thrombus invasion of the IVC or atrium is common, adrenal tumor thrombus invasive to the atrium is very rare.