Now You See Me, Now You Don't.

A 60-YEAR-OLD MALE was undergoing radical nephrectomy under transesophageal echocardiographic (TEE) guidance for renal cell carcinoma. The tumor was known to extend to the lumen of the inferior vena cava through the renal vein (Fig 1). During extraction, a large portion of the tumor was dislodged inadvertently and embolized to the superior vena cava. There was immediate significant hemodynamic instability. The patient was resuscitated with multiple bolus doses of inotropes (epinephrine). At the same time, a large and mobile echodensity was visualized in the right atrium (RA) (Fig 2).