Thrombophlebitis is a common complication among patients with malignancies due to altered coagulation. About 5-15% of patients with lower extremity thrombophlebitis develop IVC thrombosis as well. Limited information and follow up of this case prevents us from distinguishing between thrombosis of the IVC with extension into the right atrium and tumor extension into the IVC. Common tumors that extend into the IVC include renal cell carcinoma, adrenal neuroblastoma, Wilms tumor, and sarcomas which may arise directly from the wall of the IVC e.g. leiomyosarcoma.