An 83-year-old female patient (non-smoker) presented with a 3-week history of bilateral lower leg edema without toe involvement and fatigue. Due to the lack of clinical evidence of a cardiac cause, normal vital parameters, weight gain of 3 kg, and macrohematuria, we performed an abdominal ultrasound. This revealed an infradiaphragmatic right kidney mass that was infiltrating and occluding the vena cava. Abdominal computed tomography gave rise to high-grade suspicion of renal cell carcinoma (T3b N0 M1). At the patient’s request, no further diagnostic investigations were undertaken. In the further course, outpatient palliative care was provided until the patient’s death. With an incidence of 12 (women) and 26 (men) per 100 000, renal cell carcinoma is the most common form of kidney cancer in individuals aged over 65 years in Europe. Since intracaval spread occurs in 4–10% of those affected, the combination of macrohematuria and lower leg edema should prompt consideration of renal cell carcinoma in the differential diagnosis. The curative treatment approach involves radical nephrectomy with surgical thrombectomy and, if necessary, adjuvant systemic treatment.
Figure.
Contrast-enhanced abdominal computed tomography.
Coronal plane.
Black asterisk: inferior vena cava
White asterisk: abdominal aorta
Square: right kidney with inhomogeneous mass
Arrow: vein-infiltrating tumor mass
Acknowledgments
Translated from the original German by Christine Rye.
Footnotes
Conflict of interest statement: The authors state that no conflict of interest exists.