A 56-year-old man presented with aortobifemoral thromboembolism, ischaemic paraplegia, rhabdomyolysis and acute renal tubular necrosis while awaiting nephrectomy for a right renal tumour. An echocardiogram to investigate the source of embolism revealed a 7 x 3 cm mass attached to the left atrial septal wall which prolapsed through the mitral valve. The patient successfully underwent bilateral femoral embolectomy and staged operations for the excision of the left atrial mass, reported on histopathology as myxoma, and open partial nephrectomy of a high grade papillary type renal cell carcinoma. We discuss the dilemmas of diagnosis and the staging of various surgical interventions in a patient of known malignancy who presents with aortobifemoral thromboembolism with multiorgan complications and also harbours a cardiac mass which could be another thrombus, an unrelated primary benign or malignant tumour or a metastasis from the primary renal tumour.
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