Intraoperative Echocardiography as a Cornerstone in Anesthetic Care for Mayo Level IV Clear Cell Renal Cell Carcinoma with Cavoatrial Invasion in a Patient with Sickle Cell Trait.

This case report describes the successful perioperative anesthetic management of a 60-year-old woman with Mayo Level IV clear cell renal cell carcinoma and sickle cell trait who underwent radical nephrectomy, inferior vena cava thrombectomy, and right atrial thrombus excision under cardiopulmonary bypass. The anesthetic challenges included a large intracardiac mass with a high probability of producing mechanical obstruction across the right ventricular inflow and embolization, risk of massive hemorrhage, and perioperative concerns related to sickle cell trait. Intraoperative transesophageal echocardiography helped in thrombus surveillance, vascular access, cannulation guidance, and tumor clearance verification. Surrogate markers identified a subclinical hemolytic event.