Inferior vena cava and right atrial thrombosis in children with nephroblastoma: Diagnostic and therapeutic problems

Background: The neoplastic thrombus in Wilms' tumor rarely can extend in to the inferior vena cava or to the right atrium. The neoplastic thrombus usu ally is diagnosed concurrently with the tumor, although in some cases the d iagnosis of the thrombus may precede the diagnosis of nephroblastoma. Methods: Among 90 children with Wilms' tumor who were treated in the author s' unit, 4 had extensive tumor thrombosis of the inferior vena cava or the right atrium, One of these patients was found with a life-threatening throm bosis of the inferior vena cava and the right atrium, which was treated sur gically; in this case, the diagnosis of nephroblastoma was made postoperati vely. As for the 3 remaining patients the diagnosis of neoplastic thrombosi s and Wilms' tumor was made simultaneously. Results: In the first case, the patient underwent surgical excision of the thrombus with cardiopulmonary bypass and a short period of hypothermic card iopulmonary arrest. In the other 3 cases the thrombus resolved with chemoth erapy only. Conclusions: Surgical excision of extensive neoplastic thrombosis is sugges ted in the case of life-threatening thrombosis even with cardiopulmonary by pass. Chemotherapy is suggested in cases lacking clinical symptoms of throm bosis. J Pediatr Surg 35:1459-1461. Copyright (C) 2000 by W.B. Saunders Com pany.