PMC6948293_01
Dynamics of laboratory values during ICU hospitalisation. The potassium and phosphate levels decreased after the initiation of high flow continuous venovenous haemodiafiltration (CVVHDF), while calcium levels started to rise simoultaneously (a). Renal parameters showed decreasing trend after commencement of CVVHDF (b). Both conjugated and nonconjugated bilirubin showed some initial improvement. However, they remained high throughout the course of ICU-treatment (c). After initial improvement, the liver enzymes showed progressively high cholestatic pattern (c, d). Black arrows mark values above laboratory reference range ((a)-(d)).
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fig1
Laboratory tests indicated leucocytosis, increased creatinine and urea levels, elevated liver enzymes and hyperbilirubinaemia with cholestatic pattern, and impaired blood coagulation tests (Figure 1 and Table 1, time point: pre-ICU).
Computed tomography (CT) enhanced with the oral intake of diatriazoate meglumine and diatrizoate sodium contrast solutions. CT scans visualised a retroperitoneal mass of undetermined characteristics with infiltration of both iliopsoas muscles and kidneys, as shown both on sagittal and coronal views (marked with a red arrow in figures (a), (b), (e), and (f)). In the right kidney, a cyst measuring 4.5 cm was seen (marked with a white arrow in sagittal and coronal views in figures (a), (b), and (f)). An infarction zone in the spleen is shown in coronal view (marked with a blue arrow in figure (b)). There were no signs of bile duct dilation (as seen on figures (g) and (h) in sagittal view and (c) in coronal view). Sagittal view of the thorax did not show pathological changes (d). There were no specific signs of obstruction in renal system due to retroperitoneal mass, as well as no infiltration of liver and spleen (figures (a)-(c), and (e)-(h)).
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fig2
Subsequent computed tomography (CT) enhanced with orally administered diatriazoate meglumine and diatrizoate sodium solution revealed a retroperitoneal mass with complete infiltration of both iliopsoas muscles and posteromedial portions of both kidneys, separate mass in the ventral portion of the left kidney and enlarged liver and spleen (Figure 2).