Incidental IVC tumor thrombus found on echocardiographic work-up for systolic murmur leading to new diagnosis of renal cell carcinoma

Excerpt

A 55-year-old female with Hashimoto’s thyroiditis and hyperlipidemia was evaluated by her endocrinologist for an enlarging goiter. Her blood pressure was 138/72 mmHg and heart rate 87 bpm. On examination, the patient was noted to have a II/IV systolic murmur over the left sternal border that was not present one year prior; therefore, a transthoracic echocardiogram was obtained to evaluate the murmur. The echocardiogram showed minimal aortic valve sclerosis and no other valvular abnormalities; however, there was a large mass extending into the inferior vena cava (IVC) and right atrial (RA) junction consistent with a tumor thrombus. Further evaluation with contrast-enhanced computed tomography (CT) scan of the chest, abdomen, and pelvis demonstrated a 9 × 8 × 9-cm heterogeneous mass involving the mid and lower pole of the right kidney consistent with renal cell carcinoma (RCC) (Fig. 1a). Additionally, the large tumor thrombus was identified in the IVC–RA junction (Fig. 1b).

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