INTRAOPERATIVE ULTRASOUND - DETERMINATION OF THE PRESENCE AND EXTENT OF VENA-CAVAL TUMOR THROMBUS

Objectives. To report and discuss five cases of renal cell carcinoma ( RCC) in which preoperative imaging studies were equivocal with regard to the presence and extent of vena caval tumor thrombus or in which dy namic intraoperative imaging of the vena cava was advantageous. Method s. We reviewed the cases of five patients who had conflicting preopera tive imaging studies and reviewed the literature applying to this clin ical situation. Results. Two patients whose preoperative magnetic reso nance imaging studies suggested inferior vena caval tumor thrombus wer e shown, on intraoperative color Doppler ultrasound, not to have tumor thrombus but rather turbulent flow within the vena cava mimicking thr ombus. In two patients intraoperative ultrasound (IOUS) was used to im age the position of the tumor thrombus as it was manipulated to allow for safe vena caval clamp placement. In one patient we used real-time imaging to visualize thrombus extraction from the heart. Conclusions. Intraoperative ultrasound real-time imaging is beneficial in two speci fic situations: in those cases in which the presence of renal vein or inferior vena cava involvement is equivocal based on preoperative imag ing techniques and when there is a need to identify intraoperatively t he limits of a known tumor thrombus to allow subsequent safe placement of a caval clamp.