Venous migration and tumour thrombus formation are unique aspects of renal cell carcinoma and seen in about 4-10% of patients with renal neoplasms.Here we report such a case and management in our Institute.

A 22yr old male patient of American Society of Anesthesiologists I status, withrenal cell carcinoma with IVCthrombus was posted for elective radical nephrectomy and IVC thrombectomywith CPB on standby. Informed consent was obtained.Premedication with anxiolytic and antacid were administered.IntraoperativelyECG, SPO2, IBP, CVP, EtCO2, ABG, temperature and urine output were monitored.Balanced anaesthesia with endotracheal intubation was administered. Tumour was resected along with IVC thrombus and CPB was not required.

Patient was electively ventilated postoperatively for two hours as he was drowsy Another ABG two hours post extubation showed lowPaO2(66.4 mmHg) and clinically patient was tachypnoeic. He was stabilized on FiO2 of 0.6 with a Venturi mask and mechanical ventilation support was deferred. With a suspicion of pulmonary embolism(from the tumour site / IVC thrombus) a lung-perfusion scan was obtained which showed evidence of pulmonary embolism. Intravenous heparin 5000 IU 6thhourly,was started. Patient responded well to the treatment and a repeat lung perfusion scan (10 days later) showed some reduction in the extent of PE. Patient was kept under evaluation of tumour histopathology.