Renal cell carcinoma with right atrium tumor thrombus treated with radical nephrectomy and tumor thrombectomy in a patient with previous coronary artery bypass graft: a case report

Renal cell carcinoma (RCC) with inferior vena cava (IVC) and right atrium (RA) tumor thrombus (TT) is a rare occurrence and its resection is surgical challenge. Management becomes even more difficult when the TT causes hepatic vein obstruction and leads to Budd-Chiari syndrome. We report a case of 68-year-old male with right RCC with IVC and RA TT with associated Budd-Chiari syndrome. Surgical management was performed without cardiopulmonary bypass (CPB) and re-sternotomy due to the patient's previous history of coronary artery bypass grafting (CABG) for 3 vessel coronary artery disease. Through a transabdominal approach, the diaphragm was dissected off the IVC and the RA was gently pulled into the abdomen and clamped under transesophageal echocardiogram (TEE) control. As use of CPB in these surgeries is associated with increased morbidity and mortality, this organ transplant-based approach is encouraged for patients requiring resection of RCC with supradiaphragmatic TT.