CARDIOTHORACIC IMAGING: CARDIAC
Surgical resection of renal carcinoma with right atrial extension associated with an unnoticed large atrial septal defect Miriam Blanco, MD, Yolanda Carrascal, MD, and Gregorio Laguna, MD From the Cardiac Surgery Department, Clinic University Hospital of Valladolid, Valladolid, Spain. Disclosures: Authors have nothing to disclose with regard to commercial support. Received for publication Nov 4, 2014; accepted for publication Nov 4, 2014; available ahead of print Dec 11, 2014. Address for reprints: Miriam Blanco, MD, Cardiac Surgery, Clinic University Hospital of Valladolid, Ram on y Cajal Ave, 47003, Valladolid, Spain (E-mail: [email protected]). J Thorac Cardiovasc Surg 2015;149:1205 0022-5223/$36.00 Copyright Ó 2015 by The American Association for Thoracic Surgery http://dx.doi.org/10.1016/j.jtcvs.2014.11.005
FIGURE 1. A, Transthoracic echocardiogram showing the right atrial (RA) tumor (white arrow) emerging from the inferior vena caval orifice and protruding through the tricuspid valve into the right ventricle (RV) during diastole. B, The tumor origin was identified by magnetic resonance imaging. Clear renal cell carcinoma (white asterisk) and thrombotic material (white arrow) spread outside the kidney into the inferior vena cava and the right atrium.
A 52-year-old woman who was a current smoker was admitted for thoracic pain. Transthoracic echocardiography revealed a right atrial tumor extending through the inferior vena cava (Figure 1, A). Computed tomography showed multiple pulmonary microembolisms. Magnetic resonance imaging demonstrated a renal tumor invading the inferior vena cava (Figure 1, B). Opening the right atrium exposed an atrial septal defect not noticed on preoperative imaging (Figure 2, A). Radical nephrectomy and thrombus resection were performed under deep hypothermic circulatory arrest (Figure 2, B).
FIGURE 2. A, A risk for paradoxic embolism was identified during surgery. Once the right atrium was opened, a 3-cm diameter ostium secundum atrial septal defect (black arrow), not observed during preoperative imaging tests, was discovered. B, Radical right nephrectomy and resection of the thrombus and tumor were performed during the same period of deep hypothermic circulatory arrest.
The Journal of Thoracic and Cardiovascular Surgery c Volume 149, Number 4
1205
Surgical resection of renal carcinoma with right atrial extension associated with an unnoticed large atrial septal defect Miriam Blanco, MD, Yolanda Carrascal, MD, and Gregorio Laguna, MD From the Cardiac Surgery Department, Clinic University Hospital of Valladolid, Valladolid, Spain. Disclosures: Authors have nothing to disclose with regard to commercial support. Received for publication Nov 4, 2014; accepted for publication Nov 4, 2014; available ahead of print Dec 11, 2014. Address for reprints: Miriam Blanco, MD, Cardiac Surgery, Clinic University Hospital of Valladolid, Ram on y Cajal Ave, 47003, Valladolid, Spain (E-mail: [email protected]). J Thorac Cardiovasc Surg 2015;149:1205 0022-5223/$36.00 Copyright Ó 2015 by The American Association for Thoracic Surgery http://dx.doi.org/10.1016/j.jtcvs.2014.11.005
FIGURE 1. A, Transthoracic echocardiogram showing the right atrial (RA) tumor (white arrow) emerging from the inferior vena caval orifice and protruding through the tricuspid valve into the right ventricle (RV) during diastole. B, The tumor origin was identified by magnetic resonance imaging. Clear renal cell carcinoma (white asterisk) and thrombotic material (white arrow) spread outside the kidney into the inferior vena cava and the right atrium.
A 52-year-old woman who was a current smoker was admitted for thoracic pain. Transthoracic echocardiography revealed a right atrial tumor extending through the inferior vena cava (Figure 1, A). Computed tomography showed multiple pulmonary microembolisms. Magnetic resonance imaging demonstrated a renal tumor invading the inferior vena cava (Figure 1, B). Opening the right atrium exposed an atrial septal defect not noticed on preoperative imaging (Figure 2, A). Radical nephrectomy and thrombus resection were performed under deep hypothermic circulatory arrest (Figure 2, B).
FIGURE 2. A, A risk for paradoxic embolism was identified during surgery. Once the right atrium was opened, a 3-cm diameter ostium secundum atrial septal defect (black arrow), not observed during preoperative imaging tests, was discovered. B, Radical right nephrectomy and resection of the thrombus and tumor were performed during the same period of deep hypothermic circulatory arrest.
The Journal of Thoracic and Cardiovascular Surgery c Volume 149, Number 4
1205
