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Case Reports
. 2024 Oct 6;16(10):e70948.
doi: 10.7759/cureus.70948. eCollection 2024 Oct.

Wunderlich Syndrome With a Myriad of Presentations: A Case Series

Karthik M Chavannavar  1 , Sriram Krishnamoorthy  1 , Natarajan Kumaresan  1 , Chandru T  1
Affiliations
Case Reports

Wunderlich Syndrome With a Myriad of Presentations: A Case Series

Karthik M Chavannavar et al. Cureus. .

Abstract

Wunderlich syndrome (WS), characterized by spontaneous nontraumatic renal or perinephric hemorrhage, presents a significant diagnostic challenge due to its varied causes and clinical manifestations. Despite its historically high case fatality rate, prompt and accurate diagnosis combined with a multidisciplinary treatment approach has been shown to significantly improve patient outcomes. This case series discusses three patients with diverse presentations of WS, each managed with tailored therapeutic strategies involving a combination of conservative management, super selective renal artery embolization, and surgical interventions such as nephrectomy. The successful outcomes in these cases underscore the importance of high clinical suspicion, early diagnosis, and comprehensive management to mitigate the syndrome's potentially fatal consequences. Subcapsular hematomas, typically self-limiting, highlight the role of conservative management in renal preservation. This series reinforces that timely and appropriate intervention can transform the prognosis of WS from lethal to manageable.

Keywords: interventional radiology guided embolization; renal angiomyolipoma; tuberous sclerosis complex (tsc); urology emergency; wunderlich syndrome.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Institutional Research Ethics Committee issued approval CSP-MED/24/JUL/106/236. Thank you for submitting the proposal. The Institutional Ethics Committee (for Medical PG students), Sri Ramachandra Institute of Higher Education and Research (SRIHER) (DU) grants approval for publishing the case report study entitled "Wunderlich Syndrome With a Myriad of Presentations.". Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Computed tomography of the abdomen and renal angiogram images
AML: Angiomyolipoma (a) Computed tomography abdomen showing the dilated bowel loops (blue arrow) with multiple air-fluid levels indicating subacute intestinal obstruction. (b) Computed tomography of the abdomen showing bilateral renal AML, right inferior pole renal angiomyolipoma, and left renal angiomyolipoma replacing the kidney in its entirety with hematoma in the lower pole (red arrow). (c) Pseudoaneurysm of the left renal artery (blue arrow). Super selective renal artery embolization was done
Figure 2
Figure 2. Computed tomography of the abdomen and renal angiogram images
AML: Angiomyolipoma (a:) Bilateral renal AML with active bleeding from the largest lesion of the right kidney (blue arrow) causing hemo-retroperitoneum and moderate hemoperitoneum. (b) Right renal artery angiography showed a pseudoaneurysm (blue arrow) with active blush in the interpole and lower pole. (c) Post superselective renal artery embolization (blue arrow)
Figure 3
Figure 3. Computed tomography images of the abdomen
(a) A subcapsular hematoma in the right kidney with heterodense density lesion seen arising from the interpole of the right kidney (yellow arrows). (b) At 2 weeks, the subcapsular hematoma is seen to be resolving with right renal angiomyolipoma (white arrow). (c) At eight weeks, there is complete resolution of the subcapsular hematoma (white arrow)
Figure 4
Figure 4. Management algorithm for renal angiomyolipoma
RCC: Renal cell carcinoma; AML: angiomyolipoma; MRI: magnetic resonance imaging; NSS: nephron-sparing surgery; cm: centimeter; mm: millimeter
See this image and copyright information in PMC

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