Location
Moultrie, GA
Start Date
17-4-2026 12:00 PM
End Date
17-4-2026 1:00 PM
Description
Introduction: Renal cell carcinoma (RCC) is the most common type of adult kidney cancer. It originates in the lining of the renal tubules and typically affects older individuals. Symptoms can manifest as blood in urine, flank pain, and weight loss. Lab values include, but are not limited to, anemia, polycythemia, thrombocytosis, leukocytosis, high creatinine/BUN, and hypercalcemia. Although rare, RCC has the potential to invade the venous system and extend into the heart causing subsequent bilateral pulmonary embolism (PE). Cardiac involvement in renal cell carcinoma may remain clinically silent until drastic complications arise. This case highlights an atypical and life-threatening presentation of RCC with extensive intravascular tumor burden.
Case Presentation: This case presents a 73 year old male who arrived at the emergency department complaining of exertional dyspnea, pedal edema, and abdominal swelling for several weeks. Prior to this visit, he was prescribed antibiotics for these symptoms with no relief. Lab values revealed elevated BUN, creatinine, liver enzymes, alkaline phosphatase, hematuria, and urine RBCs and WBCs. Computed Tomography angiography (CTA) confirmed bilateral PE. The Abdominopelvic CT revealed evidence of a right renal mass concerning for RCC. Abdominal Magnetic Resonance Imaging (MRI) confirmed tumor thrombus within the right renal vein and inferior vena cava (IVC). Transthoracic echocardiogram further revealed an extensive intravascular tumor burden extending into the right atrium. Bilateral lower extremity Doppler ultrasound was then performed to distinguish tumor from thrombus in the pulmonary vasculature. Treatment included heparin for the bilateral PE, intravascular fluids for the elevated creatinine, and levofloxacin for concurrent pneumonia. Later in his stay, he acutely decompensated. After discussion with the patient’s family about further treatment options, they opted for comfort measures only. The patient ultimately expired soon after this decision.
Discussion: Typical management for localized RCC includes nephrectomy, ablation, and active surveillance. Management of metastatic RCC typically involves systemic therapy with monoclonal antibodies or tyrosine kinase inhibitors. Given how much this patient’s RCC had spread and the severe complications it had produced, management options seemed futile. While the final decision of comfort measures only was not the life-prolonging decision, it seemed to be the most ethical decision. Earlier imaging could certainly help catch this disease earlier. Better management of other comorbid conditions, such as diabetes, could possibly have aided in overall health of the patient. Effective treatment relies on early diagnosis and provider vigilance to be able to proceed with surgical and medical management.
Conclusion: This case presents a rare, but severe, presentation of RCC with cardiac extension and bilateral PE. Unfortunately, in this case, the patient presented to the clinic too late for effective management. It is imperative for clinicians to maintain a high index of suspicion for tumor embolism in patients presenting with PE and coexisting renal masses. Early diagnosis via lab work and imaging, as well as multidisciplinary interventions are integral to optimizing patient survival.
Embargo Period
5-26-2026
Included in
A Rare case of Renal Cell Carcinoma leading to Bilateral Pulmonary Embolism
Moultrie, GA
Introduction: Renal cell carcinoma (RCC) is the most common type of adult kidney cancer. It originates in the lining of the renal tubules and typically affects older individuals. Symptoms can manifest as blood in urine, flank pain, and weight loss. Lab values include, but are not limited to, anemia, polycythemia, thrombocytosis, leukocytosis, high creatinine/BUN, and hypercalcemia. Although rare, RCC has the potential to invade the venous system and extend into the heart causing subsequent bilateral pulmonary embolism (PE). Cardiac involvement in renal cell carcinoma may remain clinically silent until drastic complications arise. This case highlights an atypical and life-threatening presentation of RCC with extensive intravascular tumor burden.
Case Presentation: This case presents a 73 year old male who arrived at the emergency department complaining of exertional dyspnea, pedal edema, and abdominal swelling for several weeks. Prior to this visit, he was prescribed antibiotics for these symptoms with no relief. Lab values revealed elevated BUN, creatinine, liver enzymes, alkaline phosphatase, hematuria, and urine RBCs and WBCs. Computed Tomography angiography (CTA) confirmed bilateral PE. The Abdominopelvic CT revealed evidence of a right renal mass concerning for RCC. Abdominal Magnetic Resonance Imaging (MRI) confirmed tumor thrombus within the right renal vein and inferior vena cava (IVC). Transthoracic echocardiogram further revealed an extensive intravascular tumor burden extending into the right atrium. Bilateral lower extremity Doppler ultrasound was then performed to distinguish tumor from thrombus in the pulmonary vasculature. Treatment included heparin for the bilateral PE, intravascular fluids for the elevated creatinine, and levofloxacin for concurrent pneumonia. Later in his stay, he acutely decompensated. After discussion with the patient’s family about further treatment options, they opted for comfort measures only. The patient ultimately expired soon after this decision.
Discussion: Typical management for localized RCC includes nephrectomy, ablation, and active surveillance. Management of metastatic RCC typically involves systemic therapy with monoclonal antibodies or tyrosine kinase inhibitors. Given how much this patient’s RCC had spread and the severe complications it had produced, management options seemed futile. While the final decision of comfort measures only was not the life-prolonging decision, it seemed to be the most ethical decision. Earlier imaging could certainly help catch this disease earlier. Better management of other comorbid conditions, such as diabetes, could possibly have aided in overall health of the patient. Effective treatment relies on early diagnosis and provider vigilance to be able to proceed with surgical and medical management.
Conclusion: This case presents a rare, but severe, presentation of RCC with cardiac extension and bilateral PE. Unfortunately, in this case, the patient presented to the clinic too late for effective management. It is imperative for clinicians to maintain a high index of suspicion for tumor embolism in patients presenting with PE and coexisting renal masses. Early diagnosis via lab work and imaging, as well as multidisciplinary interventions are integral to optimizing patient survival.