Infrahepatic IVC Resection and Prosthetic Reconstruction for Renal Cell Carcinoma.
Hanna D Sun, William J Lain, Patrick McCarthy et al.
✦ AI-curated · Sources linked
Case in brief
A 50-year-old man with right renal cell carcinoma (RCC) presented with level II venous tumor thrombus (VTT) and underwent radical nephrectomy along with en bloc infrahepatic inferior vena cava (IVC) resection due to unexpected lateral wall invasion. Postoperatively, he was found to have clinically silent pulmonary tumor emboli, highlighting the need for thorough pre-operative assessment.
What made this case unusual
The patient exhibited a significant burden of pulmonary tumor emboli despite the low embolic risk typically associated with level II thrombi, challenging existing assumptions about the risks of lower-level VTT.
Diagnostic / clinical pearl
Clinicians should consider the potential for pulmonary tumor emboli in patients with renal cell carcinoma and venous tumor thrombus, regardless of the thrombus level.
Why it matters
This case emphasizes the importance of pre-operative chest imaging to identify occult pulmonary tumor emboli and the limitations of imaging in assessing tumor invasion of vascular structures.