case_images: PMC10811722_01
case_images: Timeline of the patient's case.
case_images: fonc-13-1331896-g001.jpg
case_images: PMC10811722_01_fonc-13-1331896-g001.jpg
case_images: f1
case_images: A 68-year-old man presented to another institution with weight loss, bilateral lower-extremity edema, lower back pain, and dyspnea on exertion ( Figure 1 ).
case_images: (A) Computed tomography (CT) scan coronal view showing a right retroperitoneal mass involving the inferior vena cava (IVC) and right kidney with tumor thrombus extending to the RA (black arrow). The hypervascular mass was 21.4 x 15.4 x 16.8 cm. (B) CT scan axial view of the IVC mass. (C) CT scan coronal view following chemoradiotherapy.
case_images: fonc-13-1331896-g002.jpg
case_images: PMC10811722_01_fonc-13-1331896-g002.jpg
case_images: f2
case_images: Contrast-enhanced computed tomography (CT) scan revealed a 16.1 x 14.6 x 20.7 cm mass in the right retroperitoneum involving and occluding the IVC with a tumor thrombus extending to the RA ( Figures 2A, B ). Upon completion, CT scan post-chemoradiotherapy showed a reduction in the size of the tumor ( Figure 2C ).
case_images: Vascular control. The clamps have been placed at the right atrium, iliac bifurcation of the inferior vena cava, left renal vein, and hepatic hilum (Pringle maneuver).
case_images: fonc-13-1331896-g003.jpg
case_images: PMC10811722_01_fonc-13-1331896-g003.jpg
case_images: f3
case_images: Pringle maneuver was performed to occlude liver blood supply ( Figure 3 ) temporarily.
case_images: (A) Milking maneuver. The inferior vena cava is divided at a level below the left renal vein and the tumor thrombus is milked down to a level below the major hepatic veins' ostia. Once the tumor thrombus has been completely milked down, the cranial clamp at the RA is relocated below the major hepatic veins' ostia, and the natural shunt through the liver re-established by releasing the Pringle maneuver. (B) The inferior vena cava has been oversewn at a level below the left renal vein and the iliac bifurcation without the use of a vascular graft. The final specimen includes the leiomyosarcoma, right kidney and adrenal, and the entire tumor thrombus.
case_images: fonc-13-1331896-g004.jpg
case_images: PMC10811722_01_fonc-13-1331896-g004.jpg
case_images: f4
case_images: The infrarenal IVC was removed en bloc along with the right kidney and right adrenal gland ( Figure 4 ) without requiring CPB or the use of a vascular graft.