Background:For renal masses accompanied by caval tumor thrombi (TT), ultrasound (US) is an inexpensive and accessible adjunct to magnetic resonance imaging (MRI). US allows for dynamic examination of TT extent and mobility. Due to the rare nature of this disease, there is a lack of specific guidance for US technique in the evaluation of TT. Objective:To present a standardized method of using point-of-care US for the evaluation of TT in patients with renal masses. Methods:The IVC can be visualized in sagittal, transverse, and coronal planes using the curved array probe. Upon visualizing anatomical landmarks such as the right atrium and the confluence of the hepatic veins, the interpreting physician can identify key features of the TT including the proximal extent, mobility, and invasiveness into the vessel wall. Results:This video demonstrates the advantages of US for the evaluation of TT. Proximal extension and IVC wall invasion of TT influence surgical incision approach, the need for special surgical maneuvers, and the involvement of other surgical specialties. TT can growth rapidly and imaging is recommended within 1-2 weeks of surgery. The accessibility of US in a point-of-care setting permits re-imaging of patients who have received their baseline MRI outside of this time interval. Additionally, US is a dynamic imaging modality that can uniquely assess TT mobility. Mobile thrombi that straddle anatomical limits such as the hepatic veins or the right atrium can potentially deescalate the need for invasive surgical procedures.
Conclusion:Point-of-care US is a useful tool for evaluating TT associated with renal masses.