CTICasesIntravascular Metastasis from Renal Cell Carcinoma (Tumor Thrombus)
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Imaging findings
CT revealed a large mass within the right ventricle and pulmonary emboli. Lung windows demonstrated numerous nodular and branching opacities with a 'beading of the vessel' sign, suggesting intravascular spread. Invasion of the pulmonary vein was also noted. Abdominal imaging showed polycystic kidney disease and a medium-sized renal cell carcinoma arising from the right kidney. PET imaging confirmed high metabolic activity in the RV mass and the pulmonary lesions.
Key takeaways
The presence of a cardiac mass, pulmonary emboli, and characteristic nodular/beaded lesions in the pulmonary vessels (tumor thrombus sign or 'beading of the vessel' sign) should raise suspicion for intravascular metastasis, particularly in a patient with a known primary malignancy like renal cell carcinoma. PET imaging can help differentiate bland thrombus from tumor thrombus by demonstrating metabolic activity. This case highlights aggressive intravascular spread of renal cell carcinoma.
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