INTRAOPERATIVE ULTRASOUND IN THE EVALUATION OF TUMOR INVOLVEMENT OF THE INFERIOR VENA-CAVA

The successful excision of genitourinary malignancies extending to the inferior vena cava relies heavily on accurate preoperative imaging. F or the majority of these patients magnetic resonance imaging, inferior venacavography, abdominal ultrasound or abdominal computerized tomogr aphy will reliably predict the extent of inferior vena caval involveme nt by tumor. However, occasionally the results of these studies will c onflict or be called into question intraoperatively. We report on 8 pa tients considered to be at risk for inferior vena caval involvement by tumor and for whom intraoperative ultrasound was obtained to clarify the presence or extent of thrombus. Five patients had renal cell carci noma and 3 had adrenal carcinoma. In all patients concern as to the ex tent or presence of tumor was based on either inconclusive preoperativ e studies or unexpected intraoperative findings. In each case intraope rative ultrasound clearly visualized the inferior vena cava and establ ished the presence or extent of tumor invasion. In 4 patients venacavo tomy was avoided as a consequence of these findings. Intraoperative ul trasound is a useful tool that can accurately assess the inferior vena cava for possible tumor invasion, especially when the presence or ext ent of tumor involvement is not definitively established preoperativel y.