Fatal tricuspid valve inflow obstruction and inferior vena cava syndrome in a child with advanced Wilms’ tumor: a case report

BACKGROUND: Wilms' tumor is the most common primary renal malignancy in children. Although tumor extension into the inferior vena cava occurs in 4-10% of cases, intracardiac involvement is rare, reported in only 1%. In resource-limited settings, delayed diagnosis and inadequate access to specialized care may lead to fatal complications. CASE PRESENTATION: We report the case of an 8-year-old Tanzanian girl presenting with a 6-month history of progressive abdominal distension, dyspnea, and lower limb edema. Imaging revealed a large right-sided renal mass with extension into the inferior vena cava and right atrium, causing tricuspid valve inflow obstruction. Despite receiving one dose each of intravenous actinomycin D and vincristine, her condition rapidly deteriorated, culminating in cardiogenic shock and death within 7 days of admission. CONCLUSION: This case underscores the importance of early recognition, prompt diagnosis, and multidisciplinary management of Wilms' tumor with intracardiac and vascular extension. It highlights the need to strengthen pediatric oncology, surgical, cardiac, and intensive care infrastructure in low-resource settings to avoid preventable fatalities.