Role of Intra-operative Transesophageal Echocardiographic Examination in Inferior Vena Cava Tumor Thrombus Removal in a Case of Renal Ewing’s Sarcoma

Abstract

Ewing’s sarcoma belongs to primitive neuroectodermal tumors. Renal Ewing’s sarcoma is an extremely rare tumor that can progress to the inferior vena cava (IVC) or right atrium (RA). Renal tumors with IVC/RA extension entail removal of the tumor, including tumor thrombus in IVC with or without the use of cardiopulmonary bypass, depending on the tumor thrombus extent. Intra-operative transesophageal echocardiography provides the latest staging of tumor thrombus, its characteristics, and mobility, guides IVC clamping for tumor removal, aids in troubleshooting hemodynamic instability, and monitors completeness of tumor removal post-procedure. Transesophageal echocardiographic examination forms an indispensable part of intra-operative management in any case of IVC tumor thrombus removal.