Intraoperative urothelial carcinoma tumor thrombus embolization to the heart: a case report

Urothelial carcinoma (UC) rarely presents with an inferior vena cava (IVC) tumor thrombus. Herein, we report the case of a patient with UC in whom the thrombus embolized to the right atrium during resection. Intraoperative echocardiography identified the large embolus measuring greater than 4 cm and prolapsing through the tricuspid valve. The tumor thrombus was removed via sternotomy. This case is significant for the following learning points: 1) tumor thrombus should be managed with care during removal as it can embolize; 2) intraoperative transesophageal echocardiography is vital in these cases; and 3) a multidisciplinary approach including cardiac surgery is imperative to ensure optimal outcomes.