1. Digging Deep: High Output Heart Failure in Renal Cell Carcinoma
Salim Hayek, MD, Robert Kung, MD, Ilie Barb, MD, Viraj Master, MD, PhD, Sarfraz Al, MD, Stephen Clements, MD 
The American Journal of Medicine 
Volume 127, Issue 1, Pages (January 2014)
DOI: /j.amjmed
Copyright © 2014 Elsevier Inc. Terms and Conditions

2. Figure 1
A right renal mass was evident on magnetic resonance imaging. (A) This T1-weighted axial image showed the right renal mass with contrast enhancement in the arterial phase. (B) A T2-weighted axial image disclosed the dilated right renal vein (2 cm) suggestive of abnormally high flow. The vein is indicated with an arrow.
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Copyright © 2014 Elsevier Inc. Terms and Conditions

3. Figure 2
This angiogram of the right renal artery exposed the large highly-vascularized mass arising from the superior renal pole.
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Copyright © 2014 Elsevier Inc. Terms and Conditions

4. Figure 3
Note the mass with necrotic center arising from the superior pole of the right kidney in this gross surgical specimen.
The American Journal of Medicine  , 22-24DOI: ( /j.amjmed )
Copyright © 2014 Elsevier Inc. Terms and Conditions

5. Figure 4
Histopathology of the patient's renal cell carcinoma was informative. (A) The tumor was a diffuse clear cell variant with vascular lakes, typical of renal cell carcinoma. (B) Thick-walled arterioles and a vein were adjacent to tumor nodules in this low-power view. (C) Arterioles with thick walls suggested high-grade flow and high pressure (medium-power view). (D) An arteriole with a thickened wall was evident on high-power magnification.
The American Journal of Medicine  , 22-24DOI: ( /j.amjmed )
Copyright © 2014 Elsevier Inc. Terms and Conditions