PMC8068460_01
Contrast-enhanced CT scan at presentation, 100 seconds after intravenous contrast. a, b Microcalcifications and severe hydronephrosis of the right kidney. A dense mass of 75 HU, corresponding to the density of a blood clot, can be seen at the transition of the pyelum to the proximal ureter and is indicated by an arrow. A slight layer of fluid around the kidney can be seen and is suggestive of inflammation. There is a delayed arrival of contrast to the right kidney compared with the left side. In a later phase of the scan, retention of contrast in the right pyelum with delayed drainage was observed. c Ground glass abnormalities (arrows) in the peripheral basal lung areas which were deemed to be remnants of COVID-19
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Fig1
The right kidney showed severe parenchymal thickening, multiple small calcifications deep in the calyces, and extensive hydronephrosis (Fig. 1).
CT scan without contrast, right after the patient had developed fever. (1) Decreased volume of pyelum/hydronephrosis compared to the previous CT scan. (2) Increased area of lower density in the renal parenchyma, suspect for extension of pyelonephritis as tissue becomes increasingly hydrous. (3) Resorption of the blood clot in the proximal ureter. There are no signs of an encapsulated abscess
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Fig2
A second abdominal CT on day three showed signs of extending pyelonephritis and resorption of the ureteral blood clod, but no indication of abscesses (Fig. 2).
Fundoscopy of the right eye, showing bleeding across the whole retina and segmental signs of an unsharp (swollen) optic disc. a Right eye: central retina, macula in the center. b Right eye: nasal retina
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Fig3
Fundoscopy showed diffuse retinal capillary micro-bleeding in the right eye, characteristic of a thrombotic venous occlusion (Fig. 3).
Contrast-enhanced CT scan. a At presentation. b, c At 4 months after discharge. There is an evident decrease in the volume of the right kidney compared to (a). Furthermore, notice the irregular aspect and decreased density of the surface of the interpolar region (b) and lower pole (c) at the site of the previous infection. This indicates scarring of the renal cortex. Multiple small concrements in the right kidney remain
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Fig4
Four months after discharge, a follow-up CT scan showed a clear decrease in the volume of the right kidney compared to the CT at admission (Fig. 4).