In this paper, the clinical condition of a 56 year old male patient is reported, with the diagnosis of renal cell carcinoma, complicated by a tumoral thrombus, extended from the renal vein into the vena cava and right atrium, who underwent surgical treatment. The operation consisted in the radical nephrectomy associated to the vena caval thrombectomy, under extracorporeal circulation, utilizing a multidisciplinary team composed by urologists, vascular and cardio-thoracic surgeons. The main features related to the diagnosis and surgical management of this case are described and discussed, according to data taken from the most recent publications of the literature on the subject.