| 56 year old patient admitted to our service due to an incidental finding of a renal mass of 5 cm in maximum diameter, left mesorenal on ultrasound during the study of a renoureteral crisis on the same side. | |
| The only antecedent was hyperuricemia. He did not report any episodes of hematuria. | |
| At the center where the diagnosis was made, an extension study was performed with chest X-ray, blood count, biochemistry and computerized tomography scan of the non-pelvic vena cava, which showed a tumor thrombus extending through the renal vein. | |
| This case was decided in the issuing center to place a filter in the inferior vena cava to prevent progression and embolization of this thrombus. | |
| Subsequently, the patient was admitted to our center to assess surgical treatment, since the issuing center did not have a cardiac surgery service. | |
| To complete the study we performed magnetic resonance urography (NMR-Uro), and angiographic study by computed tomography (CT-angio) with cavography to assess with the maximum possible accuracy the reach of the tumor thrombus and the possible in | |
| Both examinations report the retrohepatic extension of the thrombus, the apparent absence of vascular stenosis and adenopathies, as well as the presence of metallic filter immediately above the thrombus, responsible for the artifact. | |
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| With the diagnosis of stage T3bN0M0 renal neoformation with level II tumor thrombus, it was decided, together with the service of our center, to intervene on the left side nephrectomy by opening the renal vein, subcostal laparotomy | |
| Subsequently, under extracorporeal circulation with deep hypothermia and cerebral retroperfusion, the filter is removed by closing it and traction under fluoroscopic control from its insertion point at the jugular level i.e., removal of the graft with a possible patch | |
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| Pathological anatomy reveals the existence of a grade III renal adenocarcinoma arising exclusively from the renal tumor capsule, as well as from the renal vein, not exceeding the vena cava (pT3bNoMo). | |
| The patient remains in follow-up visits until a lytic lesion in the posterior lamina of the L2 is evident in the follow-up CT scan at 12 months, after performing an extension study with gammagraphy and total body CT, confirming that the lesion is treated. | |
| Currently, after 20 months of follow-up after nephrectomy, the patient is in follow-up by our department and the outpatient clinic, being asymptomatic and without signs of recurrence. | |