Abstract
A 9-year-old girl (1.33 m, 24 kg) was scheduled for a nephrectomy and extensive resection of Wilms' tumor of the right kidney extending into the inferior vena cava (IVC) and into the right atrium. Preoperative evaluation included abdominal sonography, computed tomography, and nuclear magnetic resonance imaging, which all showed a large tumor at the level of the mid and lower pole of the right kidney with invasion of the renal vein and IVC up to the level of the portal veins. The most cranial part of the intravascular mass extended into the right atrium but was judged by magnetic resonance imaging to be nontumoral thrombus. A combined surgical procedure with right nephrectomy, lymphadenectomy, opening of the IVC with tumor removal, and right atrial thrombus extraction during partial extracorporeal circulation with normothermia was scheduled. After anesthesia induction, biplane transesophageal echocardiography (TEE) (pediatric probe) (Sonos 2500 Hewlett Packard, Andover, MA) enabled visualization of the right atrium, the IVC, the right ventricular inflow with the tricuspid valve, the right ventricle, the right ventricular outflow tract, and the pulmonary artery.
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