case_images: PMC10758901_01
case_images: Contrast-enhanced CT before surgery. (a) An axial view shows an 86 mm tumor in the right retroperitoneal space. (b) In a coronal view, the apex of the tumor thrombus (yellow arrowhead) extends into the right atrium.
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case_images: PMC10758901_01_IJU5-7-30-g002.jpg
case_images: iju512660-fig-0001
case_images: Contrast-enhanced CT revealed an 86 mm tumor in the right retroperitoneal space that extended into the IVC; superiorly, it reached the right atrium, and inferiorly, it extended to the confluence of the iliac veins (Fig. 1).
case_images: Coronal views of cine MRI before surgery showing the (a) tumor apex, (b) superior portion of the IVC, and (c) inferior portion of the IVC. The red circle indicates the apex of the tumor. Blood flow is seen between the IVC and the tumor (yellow arrows). The images confirm mobility of the top margin of the tumor within the right atrium and indicate the absence of adhesions between the tumor and the IVC wall.
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case_images: iju512660-fig-0002
case_images: Furthermore, we observed blood flow between the tumor and the intraluminal wall of the upper segment of the IVC, and no adhesions were detected (Fig. 2).
case_images: Schematic drawing of the intraoperative findings. (a) The three clamping sites, namely the superior aspect of the IVC near the right atrium, above the bifurcation of the common iliac veins, and at the left renal vein, are indicated with red bars. (b) The artificial vascular replacement was performed from the inferior border of the left renal vein to above the bifurcation of common iliac vein. A minor incision was made in the IVC superior to the right renal vein to withdraw the tumor. The incision was then closed with continuous sutures.
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case_images: PMC10758901_01_IJU5-7-30-g003.jpg
case_images: iju512660-fig-0003
case_images: Clamping sites were obtained as shown in Figure 3, with the upper IVC clamp achieved by manually pressing down the tumor.