Unusual Echocardiographic Diagnosis of a Metastatic Thrombus - A Case Report

Abstract

Renal cell carcinoma has high propensity for intravascular and lymphatic spread. In one percent of such cases, tumor can reach up to the right atrium. This case reports the postoperative tumor embolization in a patient with renal cell carcinoma. An elderly female underwent a left radical nephrectomy and inferior vena cava (IVC) thrombectomy. She developed atrial fibrillation on the sixth postoperative day following the surgery in the postoperative unit. A bedside transthoracic echocardiogram detected a migrating echo dense structure moving across the tricuspid valve. Following this, she underwent an urgent right atriotomy and extraction of the tumor thrombus through cardiopulmonary bypass. The occurrence of atrial fibrillation in this patient with renal cell cancer in the postoperative period could have possibly been trigerred by a tumor thrombus in the right atrium.

Keywords

• atrial fibrillation
• atriotomy
• intracardiac thrombus
• renal cell cancer
• transesophageal echocardiogram
• transthoracic echocardiogram