•Murphy

Title: Case report of an intravascular IVC cyst diagnosed intra-operatively during radical nephrectomy for renal cell carcinoma

Body:

Here we report a unique case of an inferior vena cava cyst in the setting of a renal vein tumor thrombus. Our patient presented initially with emesis and syncope, but work up demonstrated a large right renal mass with what was believed to be tumor thrombus extending into the intra-hepatic IVC. Preoperative biopsy of the primary renal mass was positive for malignancy with evidence of spindle cells. The patient underwent right radial nephrectomy, lymphadenectomy, tumor thrombectomy and IVC reconstruction. Intra-operative ultrasound demonstrated a hypoechoic and non-vascular mass within the IVC extending to the intra-hepatic portion. En bloc resection of the right kidney, right adrenal gland, and lateral wall of IVC was undertaken. We identified a cyst within the IVC that was obstructive. Cyst cytology was benign. Complete enucleation of IVC cyst was performed. Margins of cyst wall and IVC were sent for frozen and were negative for malignancy. The IVC was reconstructed utilizing a bovine pericardial patch. The patient had an uneventful recovery. This case represents a unique presentation of an IVC cyst and our treatment modality.

Relevant history:

No significant H&P findings, incidental finding on imaging

Relevant test results:

CT demonstrating renal mass with accompanying concern for tumor extension into the IVC

Teaching points:

Unique presentation of IVC cyst with our subsequent management