Re-Evaluation of Renal Cell Carcinoma Tumor Thrombus Extension by Intraoperative Transesophageal Echocardiography

T RANSESOPHAGEAL ECHOCARDIOGRAPHY (TEE) is well accepted and extensively used by cardiologists, anesthesiologists, and cardiothoracic surgeons perioperatively to monitor cardiac function and great vessel anatomy.’ TEE remains underused in noncardiac surgical procedures, however. This oversight may be due, in part, to inadequate resources or the specialized training and qualifications necessary to perform TEE.* Alternatively, other physicians may be unfamiliar with its diagnostic capabilities. This case report describes a patient whose treatment was dramatically altered by perioperative TEE. He was brought to the operating room with a diagnosis of renal cell carcinoma and his preoperative diagnostic evaluation revealed extension of the tumor thrombus into the inferior vena cava and intrahepatic vessels. There was no tumor thrombus extension visualized above the level of the diaphragm by magnetic resonance imaging (MRI) or transthoracic echocardiography. The patient was brought to the operating room for a planned surgical resection of the tumor and subdiaphragmatic tumor thrombus.