Wunderlich's syndrome and hemorrhagic shock

Abstract

We report a case of Wunderlich's syndrome in an obese woman associated with massive retroperitoneal hemorrhage. Stable hemodynamic patient condition was obtained by selective arterial embolization. Since the first embolization of a renal angiomyolipoma in 1976 by Moorhead et al., highly selective renal arterial embolization of angiomyolipoma with rupture has become a procedure that offers greater efficacy, particularly in life-threatening cases.

Figure 1

Abdominal computed tomography scan showing a 22 × 15 cm right renal fat mass with a perirenal haematoma in the right kidney

Figure 2

(a) Right renal artery angiogram showing the principal feeding vessel and abnormal vessels containing areas of aneurysmal dilatation supplying the angiomyolipoma; (b) Angiogram after selective embolization of the upper pole branch of the renal artery with coils, demonstrating obliteration of the vascular supply to the tumour

Figure 3

Surgically resected right kidney involved by a large fatty mass located at the upper pole with signs of haemorrhage and haematoma

Figure 4

Histological section of the specimen shows that the lesion was composed of a mixture of thick walled blood vessel, fat cells, and spindle smooth muscle-like cells (H and E stain, × 10)