Adrenocortical carcinomas are rarely encountered tumors that have a ten dency to invade the inferior vena cava. The only effective therapy is complete surgical resection including the extraction of any intracaval tumor thrombus. A case of adrenal tumor with inferior vena caval involvement that manifested early as a pulmonary embolus is presented. The operative approach to intra caval extension is discussed, and operative maneuvers are illustrated.
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