Subaqua Sternal Rubs

This afternoon it was back to the Male Surgical Ward for Part II of our Urology rotation. Lo and behold, the same patient who we gleaned a history from last week was still on the ward, albeit in a different bed. This time, we were instructed to preform a complete, yet quick (1o minutes) physical exam. (Being newbies, we are a little slower, trying to make sure we don't miss anything, but managing to anyways.) Of note was a large, smooth, palpable mass that moved with respiration and spanned the entire left side of his abdomen. Evidently, a CT scan showed a possible renal clear cell carcinoma (kidney cancer), that may have invaded the Inferior Vena Cava (the major blood vessel collecting blood from the lower part of the body and returning it to the heart). Unfortunately, the type of cancer and spread to other sites in this patient carries a very poor prognosis. The urologist estimated that mean survival would be about 6 months, possibly a year.

However, this patient could die a lot sooner than that from a rather common complication. Since the tumor is invading the IVC, it results in an irregular surface on the inside of the vessel wall which promotes clot (thrombus) formation. If this thrombus were to break off and become an embolus traveling through the circulation, it would eventually reach the lungs. At this point, if it were sufficiently large enough, it would cause a pulmonary embolus, ischemia of lung tissue, and rapid death. For this reason, the urologist has scheduled surgery to excise (cut out) the tumor from the IVC, and hopefully prevent this complication. Our group has been invited to watch the surgery on Friday, which should be interesting, as it would be our first surgery in St. Vincent, despite having completed 3 surgery rotations already. (Our rotations are scheduled in the afternoon, and most surgeries are scheduled for the morning.) I just wish it could be more curative for the patient…

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