Surgical removal of adrenal cortical carcinoma complicated by intra-atrial tumor thrombus is very difficult and risky if the removal of thrombus is incomplete, leading possibly to pulmonary embolism. Application of multiplane transesophageal echocardiography during surgical operation may help notifying the size and location of tumor thrombus and also help determining the completeness of the thrombus removal. We present a case of successful removal of adrenal cortical carcinoma with tumor thrombus extension to the right atrium under comprehensive anesthetic care including continuous intraoperative transesophageal echocardiography monitoring.