The authors discuss a case of a 47-year old female, who underwent a left adrenalectomy for adrenocortical carcinoma. A few months later the tumour locally recurred and spread through the inferior vena cava into the right atrium. The tumour thrombus almost completely occluded the lumen of the inferior vena cava resulting in significant hepatic congestion, ascites and oedema of the lower extremities. The whole tumour thrombus was successfully removed through the right atrium under visual control using extracorporeal circulation in deep hypothermic (20 degrees C) circulatory arrest. The locally recurred tumour from the site of the left adrenal gland was also removed a month later. The histological examination revealed moderately differentiated adrenocortical carcinoma with a proliferation rate higher than 10%. Thereafter, patient underwent adjuvant oncological therapy and she has been disease free in the last one year. Clinical data suggest that tumour thrombus of various origin that grow into the inferior vena cava can be safely removed using extracorporeal circulation (with or without cardiac arrest), and in such cases, when the primary tumour is resectable, the prognosis is relatively good.