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While hematogenous spread of renal cell carcinoma (RCC) is common, isolated extension into the renal vein and inferior vena cava (IVC) is rare, and extension into the right atrium is even less likely. This 62-year-old Hispanic woman was admitted for a suspected inferior myocardial infarction; her echocardiogram revealed a right atrial mass consistent with an atrial myxoma. The atrial mass was excised during coronary artery bypass surgery, and the histology was consistent with metastatic clear cell RCC. Computed tomography of the abdomen demonstrated a 5 cm right lower pole renal mass with hilar involvement and filling defects in the IVC and the right renal vein; these findings were consistent with RCC tumor thrombus extension into the renal vein, IVC, and right atrium. The radical nephrectomy necessary for tumor removal could not be performed at this hospital, and the patient was discharged to a higher level of care. The incidence of RCC with extension into the right atrium is quite low, but clinicians should understand that the lethality of RCC warrants immediate clinical investigation upon diagnosis.

A rare case of renal cell carcinoma with hematogenous extension into the right atrium discovered incidentally on echocardiogram