V13-09 TRICUSPID INSUFFICIENCY CAUSED BY RENAL ANGIOMYOLIPOMA WITH EXTENSION TO THE INFERIOR VENA CAVA AND RIGHT ATRIUM. A MULTIDISCIPLINARY APPROACH

Abstract

You have accessJournal of UrologyCME1 May 2022V13-09 TRICUSPID INSUFFICIENCY CAUSED BY RENAL ANGIOMYOLIPOMA WITH EXTENSION TO THE INFERIOR VENA CAVA AND RIGHT ATRIUM. A MULTIDISCIPLINARY APPROACH Ruben Santiago, Omar Vieyra, Rodrigo Perez, Victor Osornio, Gerardo Garza, Roberto Lopez, and Mario Ortega Ruben SantiagoRuben Santiago More articles by this author , Omar VieyraOmar Vieyra More articles by this author , Rodrigo PerezRodrigo Perez More articles by this author , Victor OsornioVictor Osornio More articles by this author , Gerardo GarzaGerardo Garza More articles by this author , Roberto LopezRoberto Lopez More articles by this author , and Mario OrtegaMario Ortega More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002646.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Renal angiomyolipoma (AML) is a mesenchymal tumor benign composed by vascular, smooth muscle and adipose tissue. There are two types of AMLs: The classic variant is the most common and is characterized by thick walled vessels, spindle smooth-muscle-like cells and adipose tissue. The epithelioid variant has an epithelial cell component to it with minimal adipose tissue and has the potential to undergo malignant transformation. The objective of this video is presented the multidisciplinary approach from surgical technique to medical intensive care during and after the surgery. METHODS: A 44-year-old woman was referred by his primary care physician with symptoms characterized by shortness of breath, tachycardia, intermittent hematuria and right lumbar pain. Physical examination with holosystolic murmur. Computerized tomography (CT) scan demonstrated a 6.1x5.1cm right renal tumor, the attenuation was - 83 Hounsfield Units (HU) with tumor thrombus invasion into the inferior vena cava, which extended from renal vein ostium to right atrium. Magnetic resonance imaging (MRI) showed non-infiltration of the vena cava wall. Echocardiogram presented systolic protrusion of the thrombus towards the right ventricle, developing moderate tricuspid regurgitation. RESULTS: With multidisciplinary management (Urology, cardiology, cardiothoracic surgery, perfusionists and intensive care therapy) were performed an open right radical nephrectomy, sternotomy, cavotomy with extraction of intra-atrial thrombus and primary cavorrhaphy. With support of cellular recuperator and extracorporeal circulation pump (pump time 100 min) trans-surgical transfusions were: 3 erythrocyte concentrates, 2 fresh frozen plasmas and 1 platelet apheresis. Surgical time was 380 min. During the surgery a real-time transesophageal echocardiogram was used. Bleeding was 2500 ml and no intraoperative complications were reported. Hospital stay of 20 days, discharged without complications with serum creatinine 1.0 mg / dl and hemoglobin 11.5 g / dl. Pathology report was renal classic AML, size 8.0x6.0x4.0cm, immunohistochemistry: HMB45 (+) and smooth muscle actin (+). CONCLUSIONS: This is a rare case of a classic AML presenting with a venous tumor thrombus involving the inferior vena cava from renal vein ostium to right atrium. Radical nephrectomy with tumor thrombectomy is the most widely accepted surgical treatment following established vascular principles of venous tumor thrombectomy. Source of Funding: Non Disclousure © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e1033 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ruben Santiago More articles by this author Omar Vieyra More articles by this author Rodrigo Perez More articles by this author Victor Osornio More articles by this author Gerardo Garza More articles by this author Roberto Lopez More articles by this author Mario Ortega More articles by this author Expand All Advertisement PDF DownloadLoading ...