Wünderlich's syndrome in a haemodialysis patient

Abstract

Wünderlich's syndrome, or spontaneous renal haemorrhages, are rare, atraumatic, intraparenchymal and perirenal haemorrhages, which are difficult to diagnose and can be potentially fatal.Patients who are dialysis-dependent are at an increased risk of bleeding, due to an association between uraemia and platelet dysfunction; for this reason, the use of double antiplatelets is avoided in this cohort. Case studies exist demonstrating spontaneous bleeds in these patients.Fish oil is used increasingly within medicine: however, it is known to interfere with platelet aggregation, therefore, theoretically increasing the tendency to bleed. The topic remains under debate, with systemic reviews refuting a correlation between intraoperative and postoperative bleeding and fish oil consumption. There is, however, an absence of literature on the adverse effects of fish oil when taken in large quantities.This case study explores the case of a patient who had a spontaneous renal bleed following a large, self-medicated dose of fish oil.

Keywords: Dialysis; Interventional radiology.

Figure 1

(A) Arterial phase demonstrating the large haematoma. (B) Portal venous phase demonstrating a small focus of contrast accummulation at the posterior mid pole level of the renal parenchyma. (C) Delayed phase scan showing the enhancing renal parenchyma (orange arrow) without a significant accumulation of contrast. Bleeding likely from a capsular vessel, whether arterial or venous with no obvious supplying vessel evident.