PMC6381912_01
A-C. Coronal CT reconstruction in early venous phase after i.v. contrast application, depicting primary tumor and vascular extent. D-F. Ultrasound images in Doppler mode highlighting hepatoatrial transition (D) as well as atrial dilation and movement of the sacciforme intravascular tumor extension over the tricuspid valve into the right cardiac ventricle (E and F). All depicted images represent the initial diagnosis.
cro-0012-0033-g01.jpg
PMC6381912_01_cro-0012-0033-g01.jpg
F1
Abdominal ultrasound and echocardiography as well as subsequently performed MRI and CT-scans led to the radiology-based diagnosis of WT of the right kidney with continuous vascular growth up into the right cardiac ventricle (Fig. 1).
A. Intravascular tumor extensions along centimeter scale: * subhepatic VCI; ** intrahepatic VCI; *** intracardiac. B. Dissected kidney along centimeter scale.
cro-0012-0033-g02.jpg
PMC6381912_01_cro-0012-0033-g02.jpg
F2
The intracardiac tumor extension could be completely resected, but intrahepatic VCI showed short-segment vessel-adhesive tumor elements with retrograde growth into the liver veins, which could not be securely resected completely nor repaired with a pericardial patch, which led to a grading of SIOP-stage III instead of stage I due to intravascular R2-resection (Fig. 2).