Abstract
We present a case of a 63-year-old male with a history significant for hypertension and a 45-pack-year smoking history who presented with severe symptomatic anemia. Rather quickly, upon imaging, he was found to have a 10 cm liver mass, a right renal mass, and a right atrial mass. A liver biopsy was performed and confirmed metastatic renal cell carcinoma (clear cell variant). Due to the extensive disease burden and patient preference, curative surgery was not pursued. This case highlights the rare but critical complications that can present as the initial presentation of renal cell carcinoma.