Document Type
Poster
Version Deposited
Published Version
Publication Date
3-2026
Conference Name
2026 Camden Scholar's Forum
DOI
10.31986/issn.2689-0690_rdw.cmsru_fac_pub.1062
Abstract
Introduction: Renal cell carcinoma (RCC) commonly invades the renal vein, and in advanced cases, the inferior vena cava (IVC). Standard management of localized RCC with venous thrombus is surgical resection, often requiring radical nephrectomy ± tumor thrombectomy. We present a unique case in which sequential intraoperative tumor embolization and post-cardiopulmonary bypass systolic anterior motion (CPB SAM) created a rare, complex hemodynamic cascade, highlighting challenges in the perioperative management of advanced RCC.
Case Description: A 71-year-old female with a history of hypertension was diagnosed with a large left renal mass with tumor thrombus extending into the left renal vein and IVC, consistent with clinical stage T3 RCC. Preoperative imaging suggested the thrombus was confined to the IVC; however, intraoperative transesophageal echography (TEE) demonstrated a mobile tumor thrombus extending into the right atrium during open radical nephrectomy and planned IVC thrombectomy. During surgical manipulation, the patient developed sudden hypoxia and hemodynamic collapse, progressing to pulseless electrical activity arrest. Return of spontaneous circulation was achieved after cardiopulmonary resuscitation. Emergency sternotomy and cardiopulmonary bypass were initiated after suspected embolization of the right atrial tumor thrombus to the pulmonary artery. Surgical embolectomy removed a 12 cm thrombus. Following bypass, persistent hypotension prompted TEE, which demonstrated SAM of the mitral valve with dynamic left ventricular outflow tract obstruction. Hemodynamic stability improved with volume resuscitation, afterload augmentation, and reduction of inotropic support.
Discussion: Tumor embolization during nephrectomy for RCC is a rare, but life-threatening intraoperative complication that may present with abrupt cardiopulmonary collapse. Intraoperative TEE plays a key role in identifying tumor extension and guiding surgical management. Post-CPB SAM represents an additional, underrecognized cause of hemodynamic instability related to altered ventricular loading conditions and hyperdynamic ventricular function. Prompt echocardiographic recognition was important since treatment differs from other causes of post-bypass hypotension and requires volume loading and afterload augmentation rather than inotropic support.
Recommended Citation
Pruthi, Anika; Mcloughlin, Christopher; Thomas, Robert; and Trivedi, Keyur, "A Hemodynamic Cascade: Tumor Embolism and Post-Bypass Systolic Anterior Motion During Nephrectomy" (2026). Cooper Medical School of Rowan University Departmental Research. 59.
https://rdw.rowan.edu/cmsru_facpub/59
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
