Wunderlich syndrome
Dr Saeed Soltany Hosn and Dr Praveen Jha et al.
The Wunderlich syndrome is a rare condition, where spontaneous renal haemorrhage occurs into the subcapsular and perirenal spaces 2.
Clinical features
The Wunderlich's syndrome is clinically characterized by the Lenk's triad which are
- acute flank pain
- a flank mass and
- hypovolemic shock
Pathology
Aetiology
-
neoplastic :
- neoplasms are the most common cause.
- among benign neoplasms, angiomyolipoma are the commonest, while among malignancy, renal cell carcinoma are the commonest.
- cases in tuberous sclerosis related angiomyolipomas have been reported1 .
-
non-neoplastic :
- vascular causes - vasculitis (polyarteritis nodosa being most common cause), renal artery aneursyms, AV malformations and fistulas, venous thrombosis.
- cystic renal diseases
- calculus disease
- nephritis
- coagulation disorders
Radiographic features
General
Haemorrhage is seen in perinephric region, often with a primary lesion seen within the kidney e.g. angiomyolipoma, renal cell carcinoma etc.
Treatment and prognosis
If the haemorrhage is self limiting and patient is responsive to fluid resuscitation, patient can be managed conservatively. Angiographic selective embolization is also recommended. In hemodynamically unstable patients, however emergent nephrectomy (partial / total) is advised3.
Etymology
It is named after the German physician Carl Reinhold August Wunderlich
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