Wunderlich's syndrome in pregnancy: a shocking triad

Abstract

Wunderlich's syndrome, non-traumatic renal haemorrhage into the subscapular and perinephric space, in pregnancy, is a very rare clinical entity. We describe a case of Wunderlich's syndrome in a 29-year-old gravida 5 para 4 who presented to our emergency department with sudden onset severe left flank pain. On assessment, she was clinically shocked-hypotensive, tachycardic and perfused poorly peripherally. Ultrasound of the abdomen and pelvis and subsequent MRI of the left kidney revealed a large hypervascular exophytic lesion arising from the left renal pole-appearance consistent with an angiomyolipoma. This specific presentation is clinically characterised as Lenk's triad-acute flank pain, flank mass and hypovolaemic shock. The patient was adequately resuscitated and interventional radiological embolisation of the mass was performed. She went on to have an uneventful pregnancy and delivered vaginally after induction at 38 weeks of gestation.

Keywords: obstetrics and gynaecology; urology.

Figure 1

MRI image of abdomen showing left-sided renal mass in the upper renal pole with retroperitoneal haemorrhage.

Figure 2

MRI image of abdomen showing the left-sided renal mass in the upper renal pole.

Figure 3

IR fluoroscopy image of left renal angiomyolipoma, prior to embolisation. IR, interventional radiological.

Figure 4

IR fluoroscopy image of left renal AML, postembolisation. IR, interventional radiological.