Radiologic Evaluation and Management of Metastatic Renal Cell Carcinoma with Tumor Thrombus Extension into Right Atrium

This case report discusses the radiologic evaluation, histopathology, and management of a 67-year-old female with metastatic renal cell carcinoma (RCC) extending as a tumor thrombus into the right atrium. The patient had newly developed hematuria that was not followed up with the recommended imaging modality. Months later, the patient presented to the emergency department with progressive hematuria in addition to symptoms of dyspnea and significant weight loss. Initial CT imaging revealed a large renal mass with metastasis to the liver and lungs, along with tumor thrombus invading the inferior vena cava and right atrium. Histopathologic evaluation confirmed metastatic RCC and utilized in conjunction with the imaging studies to verify cancer staging. Combination immunotherapy with pembrolizumab and lenvatinib was initiated by the oncologist. This case emphasizes the importance of a comprehensive radiologic and clinical evaluation of hematuria as well as adequate workup to verify and stage RCC.