Budd-Chiari syndrome secondary to caval recurrence of renal cell carcinoma.
BACKGROUND
Renal cell carcinoma (RCC) involves the inferior vena cava (IVC) in a minority of patients. Less commonly, it presents with Budd-Chiari syndrome. If untreated, the condition progresses towards liver failure and death.


METHODS
We report a case of Budd-Chiari syndrome due to infiltration of the IVC and right atrium by recurrence of RCC 7 years after successful treatment by primary resection.


RESULTS
Surgery was performed with a combined abdominal and thoracic approach with cardio-pulmonary by-pass and cardioplegia. The tumor was removed and a cadaveric iliac vein graft used to re-establish venous continuity between the right atrium and hepatic veins.


CONCLUSIONS
Although it is a complex and high-risk procedure, aggressive surgery performed by an experienced team with liver transplant and cardiothoracic skills may enable resection of apparently advanced caval tumors. The case is discussed in the light of the current literature.
Institute of Liver Studies, King's College London School of Medicine at King's College Hospital, Denmark Hill, London, UK. gabrielemarangoni@virgilio.it
Gabriele
G
Marangoni
Adrian
A
O'Sullivan
Amir
A
Ali
Walid
W
Faraj
Nigel
N
Heaton
D006502:Budd-Chiari Syndrome / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D002292:Carcinoma, Renal Cell / Q000150:complications / Q000473:pathology* / Q000601:surgery; D002315:Cardiopulmonary Bypass; D006324:Heart Arrest, Induced; D006325:Heart Atria / Q000473:pathology / Q000601:surgery; D006801:Humans; D007084:Iliac Vein / Q000637:transplantation; D007680:Kidney Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009360:Neoplastic Cells, Circulating / Q000473:pathology*; D009392:Nephrectomy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures; D014682:Vena Cava, Inferior / Q000473:pathology* / Q000601:surgery