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A 70 year old woman presented to the emergency department with dyspnoea and fever of a few weeks duration. Transthoracic echocardiography revealed a mass extending from the inferior vena cava to the right ventricle, with prolapse through the tricuspid valve (panel A). Magnetic resonance imaging (MRI) confirmed that the mass originated from the superior pole of the right kidney (panel B). The mass was successfully resected in two segments via a thoracic and abdominal approach. Histologic examination confirmed that the lesion was a clear cell carcinoma. The patient was discharged from the hospital 18 days after surgery.