Figure 1. Color Doppler ultrasound of the left kidney. (A) Renal vein thrombosis in the left renal hilum measuring 51×23 mm (blue and red dotted lines) (B) Left kidney swollen and larger than normal with a longitudinal diameter of 168 mm (green dotted line)
At admission, a spiral chest CT scan without contrast due to the COVID-19 pandemic along with relevant tests were performed. In lung imaging, the heart had a normal size. A 5 mm nodule with a sharp edge and without calcification component a similar nodule, 6.5 mm in diameter, in the lateral segment of its right middle lobe and a 10 mm nodule in the left lower lobe was observed in the right upper lobe. A number of atelectatic bands were evident in both lung parenchyma. Due to the recent viral pneumonia, several focal alveolar subsegmental and peripheral ground-glass opacities were evident in the lung parenchyma (Figure 2). Mediastinal lymphadenopathy and mass were not evident in the mediastinum. In the initial laboratory tests, the patient had anemia (Hb: 11.7 g/dl and Hct: 35.4 % and MCV: 81 fl), slightly increased creatinine (Cr: 1.5 mg/dl ), high erythrocyte sedimentation rate (ESR 1st hr: 72 mm/hr) and C-reactive protein (CRP: 3⁺), and hematuria (blood/Hb: 3⁺and RBC: 15-20). Coagulation and liver functional tests and other biochemical tests were normal. He was admitted and tested for COVID-19 with real-time reverse transcription-polymerase chain reaction (RT-PCR). Anticoagulation was started with intravenous injection of heparin 5000 U stat continued with heparin infusion (1000 U/h). Partial thromboplastin time (PTT) was checked every six hours to ensure it was maintained between 60 and 80 seconds. The result of RT-PCR test was negative two days after admittion.