Ewing's sarcoma of kidney extending into IVC and RA: resection using modified cannulation strategy for CPB

Abstract

Ewing's sarcoma of the kidney is a rare tumor. Although renal carcinomas are known to involve the inferior cava, extension of the tumor up to the right atrium is not common. In the majority of cases when the tumor extends into the infrahepatic part of the inferior vena cava, it can be removed from the abdominal approach. Few patients require the use of cardiopulmonary bypass for removal of the tumor in the inferior vena cava and right atrium. The management of patients requiring resection of kidney tumors and right atrial mass is more complicated and requires a team approach consisting of oncosurgeons, cardiac surgeons, and cardiac anesthetists. The resection of the kidney tumor with a mass in the right atrium is usually done concomitantly. The cardiopulmonary bypass cannulation strategy needs to be modified in such cases.

Keywords: Cardiopulmonary bypass; Ewing’s sarcoma; Kidney tumor; Partial sternotomy; Right atrial mass; Total circulatory arrest.

Fig. 1

A CT (computed tomographic) scan (abdomen) axial section showing a mass in the IVC (inferior vena cava); B CT scan (thorax) axial section showing a mass in RA (right atrium); C CT scan (abdomen), coronal section showing a mass in the right kidney; D resected specimen of the renal mass

Fig. 2

A Operative image of infrarenal IVC (inferior vena cava) cannulation and CPB (cardiopulmonary bypass) circuit; B operative image of mass in RA (right atrium)

Fig. 3

A Operative image of extraction of mass in RA (right atrium) using deep hypothermic circulatory arrest (DHCA); B operative image showing cannula in suprahepatic IVC (inferior vena cava) and infrarenal IVC after removal of a mass in the RA and IVC