Purpose Renal cell carcinomas (RCCs) account for 90% of renal tumours. One percent of RCCs extend through the renal vein to the inferior vena cava (IVC) and right atrium (RA). Atrial wall metastasis without IVC involvement is rare. This case of cardiac metastases from clear cell RCC sparing the IVC highlights options for palliative cardiothoracic debulking to prevent obstructive shock and prolong life. Methodology Case selection included patients at Royal North Shore Hospital with cardiac metastases from RCC. Results A 72-year-old male with biopsy-proven high-grade RCC 20 months post-cytoreductive nephrectomy presented with exertional dyspnoea secondary to disease progression. A 55 mm x 34 mm x 49 mm right lateral atrial free wall lesion extending to the left atrium, pericardium, and superior vena cava (SVC) while sparing the IVC caused partial SVC obstruction. Concern for debilitating symptoms and imminent death from obstructive shock guided recommendation of palliative debulking. The tumour was seen invading the pericardium overlying the RA and SVC junction and around the left atrial roof. The mass was debulked where possible. A bovine pericardial patch closed and augmented the RA, minimising obstruction of cavae to atrial flow. The patient’s symptoms improved and they were discharged after 8 days with palliative services. After an initial period of wellness, the patient passed away three months later. Conclusion This rare case highlights the potential for RCC myocardial metastasis in the absence of IVC extension and describes options for palliative cardiothoracic debulking to prevent obstructive shock and prolong life.