A tale of Wünderlich syndrome

Abstract

Wunderlich syndrome is a rare entity characterized by acute onset of spontaneous, non-traumatic renal hemorrhage into the subcapsular and perirenal spaces. It can be fatal if not promptly recognized clinically and treated aggressively. We report a case of a 63-year-old Caucasian female who was presented to the emergency department with acute onset of sharp abdominal and right flank pain, and hypotension. An urgent abdominal and pelvic computed tomography scan with contrast demonstrated a large (13 × 12 × 8.5 cm) right perinephric hematoma of unknown etiology. The patient subsequently underwent renal angiogram that demonstrated active extravasation of the right superior renal artery. She underwent successful embolization procedure and responded well to fluid resuscitation. She remained hemodynamically stable and was discharged home without further events.

Figure 1:

Peri- and paranephric hematoma filling the right retroperitoneum. Pre-contrast and contrast enhanced abdominal and pelvic CT with (A) axial, and (B and C) coronal views. The hematoma distends the renal fascia, crosses the midline and displaces other peritoneal and retroperitoneal structures. Free fluid, and a hyperdense focus of vascular contrast is present adjacent to the hematoma (best seen in A). An incidental ∼18 mm right lower pole renal calcification (B). The estimated size of the hematoma was 13 × 12 × 8.5 cm. Incidental finding of cholelithiasis (C)

Figure 2:

Identification and subsequent embolization of an active extravasation from the superior right renal artery. (A) Renal angiogram of the right kidney prior to embolization. Both a superior and an inferior right renal arteries are present. There is an active extravasation of blood from the subsegmental branch of the superior right renal artery. (B) Post-embolization renal angiogram. There is no definitive focus of active extravasation