Among the perplexing systemic L manifestations of renal cell carcinoma is cardiac enlargement, possibly associated with signs of circulatory congestion. One of the causes of the cardiomegaly is left to right shunting due to arteriovenous fistula formation in the tumor or its metastatic deposits. Nineteen cases of this vascular anomaly in the primary tumor have been reported since Hamilton and co-workers published the first case in 1953.1-17 Only two of the 19 reports9,13 have included preoperative and postoperative hemodynamic studies. This sparsity of hemodynamic information prompted us to describe the following case in which such studies were performed with a recognized method of shunt detection.
A 38-year-old white woman was in good health until February 1970 when she developed acute left flank pain and gross hematuria. She was hospitalized for a similar episode one month later. At that time, a chest roentgenogram (Fig 1) and