# Case report: right radical nephrectomy with thrombectomy in a patient with renal tumor, retrohepatic inferior vena cava agenesis, and tumor extension to the azygos vein

## TL;DR

This case report describes a rare kidney cancer with unusual vein anatomy and thrombosis, emphasizing the need for multidisciplinary care.

## Contribution

The case highlights a rare vascular anomaly combined with renal tumor and thrombosis, offering insights into surgical and therapeutic management.

## Key findings

- The patient had agenesis of the retrohepatic inferior vena cava with hepatic veins draining directly into the right atrium.
- A thrombus extended from the renal tumor into the azygos vein, requiring radical nephrectomy and thrombectomy.
- Multidisciplinary management and neoadjuvant therapy are critical for reducing risks in such complex cases.

## Abstract

Renal cell carcinoma accounts for 90% of malignant kidney tumors, but only 6% of patients typically present with associated thrombosis. We present the case of a male patient with a vascular anoma ly characterized by agenesis of the retrohepatic portion of the inferior vena cava. The hepatic veins drain directly into the right atrium, while the azygos vein serves as an alternative venous pathway, draining into the superior vena cava. A thrombus extends through the azygos vein into its intrathoracic portion. This vascular variant is associated with a right renal tumor and thrombosis involving the azygos vein. The aim is to highlight the importance of multidisciplinary management, neoadjuvant therapy, and surgical treatment to reduce morbidity and mortality in these cases.