Wunderlich's syndrome (spontaneous renal haemorrhage)

Abstract

Wunderlich's syndrome is a rare condition characterised by spontaneous non-traumatic renal haemorrhage into the subcapsular and perirenal space. The commonest cause of Wunderlich's syndrome is renal neoplasms, with angiomyolipoma and renal cell carcinoma being the most common benign and malignant lesions, respectively. We report a case of Wunderlich's syndrome in a 46-year-old woman. She presented in the emergency department with the chief complaints of sudden onset of abdominal pain with no significant medical history. Imaging findings and clinical history led to the diagnosis of Wunderlich's syndrome. The patient underwent left partial nephrectomy and recovered without any complications. She is presently doing well.

Figure 1

An ultrasound of the abdomen showing a heterogeneous, predominantly echogenic, lesion at the upper pole of the left kidney with adjacent complex collection in the left perinephric space.

Figure 2

A colour Doppler ultrasound of the left renal area showing intralesional vascularity, differentiating the echogenic mass from haemorrhage. M, mass; K, lower pole of the kidney.

Figure 3

An axial non-contrast CT scan of the abdomen at the level of L1 vertebra showing a soft-tissue mass lesion with areas of fat attenuation arising from the upper pole of the left kidney, with no evidence of any calcification but with evidence of haematoma formation around it.

Figure 4

An axial contrast-enhanced CT scan of the abdomen at the level of L1 vertebra showing a large, well-defined, soft-tissue mass lesion with areas of fat attenuation arising from the upper pole of the left kidney, with evidence of haematoma formation around it.

Figure 5

An axial contrast-enhanced CT scan of the abdomen 1 cm below figure 4 showing a normally enhancing kidney forming a crescent posterior to the mass, with perinephric haematoma.