Abstract
A 53-year-old male presented with bilateral lower extremity (BLE) swelling, abdominal distention, dyspnea, and a newly identified, locally advanced 4.7 cm right renal mass with tumor thrombus (TT) extending into the inferior vena cava (IVC) up to the right atrium (RA) without evidence of distant metastases (Figure 1A). He was also found to have BLE deep vein thromboses (DVT) and was started on anticoagulation. Plans were made for nephrectomy with tumor thrombectomy; however, he developed transaminitis, worsening ascites, and BLE edema, necessitating transfer to the intensive care unit (ICU).
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