Fluctuating Cutaneous Varices

A 72-year-old man presented with altered consciousness. His past medical history included left renal cell carcinoma status post nephrectomy 3 years earlier, end-stage renal disease with regular hemodialysis, and central venous obstruction with stenting at the right subclavian vein and superior vena cava 8 months earlier. He was intubated and placed on a mechanical ventilator and inotropes for managing respiratory failure and shock. After numerous tests, demonstrated in the following video series, it was evident that a right atrial mass was hindering blood flow into the right ventricle and causing blood to flow back into the peripheral venous system.

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