When renal or liver masses are identified, which vascular structures should be evaluated to assess for thrombus?

• A. Only kidneys; to assess size.
• B. Veins and IVC through to the right atrium.
• C. Fracture risk assessment.
• D. Liver function tests only.

Answer: (B)

When a renal or liver mass is identified, you must trace the venous pathways that drain these organs because a tumor can grow as a thrombus within those vessels. A tumor thrombus from the kidney often extends from the renal vein into the inferior vena cava and can reach the right atrium. A liver mass can invade the hepatic veins and likewise extend into the IVC and sometimes the right atrium. So the vascular assessment should evaluate the renal veins, the IVC, and up to the right atrium to determine the full extent of any thrombus. Other options miss this key point: focusing only on the kidneys won’t catch venous invasion, and fracture risk or liver function tests don’t evaluate intravascular extension. Imaging with contrast-enhanced CT or MRI, with Doppler as needed, is used to detect and map the thrombus.