case_images: PMC10764280_01
case_images: Pre-operative MRI showing tumor thrombus extending into the IVC below the major hepatic veins.
case_images: JKCVHL-10-043-g001.jpg
case_images: PMC10764280_01_JKCVHL-10-043-g001.jpg
case_images: F1
case_images: She presented to an outside hospital with hematuria and was found to have a 10 cm renal mass with tumor thrombus extending into the vena cava below the main hepatic veins (Mayo level II tumor thrombus) (Figure 1).
case_images: Pre-operative TEE showing friable thrombus tip.
case_images: JKCVHL-10-043-g002.jpg
case_images: PMC10764280_01_JKCVHL-10-043-g002.jpg
case_images: F2
case_images: Due to the friable tip of the thrombus (Figure 2), a decision was made to approach this as a level III tumor thrombus with suprahepatic control to avoid the extensive IVC manipulation required to release significant portions of the caudate and obtain an infrahepatic clamp.
case_images: Intraoperative TEE showing tumor thrombus in the right atrium.
case_images: JKCVHL-10-043-g003.jpg
case_images: PMC10764280_01_JKCVHL-10-043-g003.jpg
case_images: F3
case_images: This prompted the urologic surgeon (SD) to request TEE review, which revealed tumor thrombus filling most of the right atrium (Figure 3).