Education  |   November 2019
Resection of an Adrenocortical Carcinoma Invading the Inferior Vena Cava Extending into the Right Ventricle
Author Notes
  • From the University of Miami/Jackson Memorial Hospital, Miami, Florida.
  • Address correspondence to Dr. Abalo: miguel.abalo@jhsmiami.org
Article Information
Education / Images in Anesthesiology / Cardiovascular Anesthesia / Endocrine and Metabolic Systems
Education   |   November 2019
Resection of an Adrenocortical Carcinoma Invading the Inferior Vena Cava Extending into the Right Ventricle
Anesthesiology 11 2019, Vol.131, 1149-1150. doi:https://doi.org/10.1097/ALN.0000000000002866
Anesthesiology 11 2019, Vol.131, 1149-1150. doi:https://doi.org/10.1097/ALN.0000000000002866
Adrenocortical carcinoma (ACC) is an uncommon and aggressive tumor with the potential to invade the inferior vena cava (IVC) and spread to the right atrium (RA) and right ventricle (RV) (image A).
Perioperative evaluation of a patient with a tumor invading the inferior vena cava includes a comprehensive analysis of the preoperative imaging studies (echocardiogram, computer tomography, or magnetic resonance) to assess for tumor extension and structures affected. Ultimately, tumor extension will determine the anesthetic management. Tumors occluding the inferior vena cava require large-bore central venous access above the diaphragm. Pulmonary artery catheter placement may not be recommended if the tumor is spreading into the right atrium because of the risk of tumor embolism.1  Hepatic vein invasion may affect drug metabolism and coagulation. Increased collateral circulation will also potentiate the risk of intraoperative bleeding. Significant ascites places the patient at a higher risk for aspiration.