PMC5958993_01
12-lead electrocardiogram - sinus rhythm, heart rate 72 beats/minute, QRS axis +15 , ST segment elevation in V1-V6, D I and aVL.
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The 12-lead electrocardiogram was immediately recorded, showing ST-segment elevation in V1-V6, lead I and aVL, without mirror image (Figure 1).
Echocardiogram - apical 4 chamber view showing apical ballooning.
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An echocardiography was performed in the emergency service, revealing wall-motion abnormalities of the left ventricle - severe mid-ventricular hypokinesia, apical ballooning and basal hypercontraction, with a left ventricle ejection fraction of 40% (Figure 2).
Contrast-enhanced CT - Figure 3A. Axial view: suprarenal, irregularly shaped tumor, 8.7/12.7/12.0 cm, with heterogeneous aspect, central necrosis, and infracentimetric calcifications; the mass invades the left renal vena cava by a tumoral thrombus, 7.3 cm long, extending to the origin of the inferior vena cava, and displaces the splenic vein anteriorly, without impeding the flow. Collateral circulation is visible around the mass. Figure 3B. Axial view: The left kidney is enlarged due to two simple cortical cysts (inferior pole) and a medio-renal natively hypodense lesion of 2.7/4.2/3.7 cm, with heterogeneous contrast enhancement, suggesting a Bosniak III renal cyst.
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Tomography (CT). The contrast-enhanced CT scan showed a heterogeneously enhancing left suprarenal tumor of 8.7/12.7/12.0 cm, graded T4NxM0, with invasion into the left renal vein, left renal vein thrombosis and a left renal tumor, graded T3NxM0 (Figure 3).