Wunderlich syndrome is a rare condition, in which spontaneous nontraumatic renal haemorrhage occurs into the subcapsular and perirenal spaces 2.
Wunderlich syndrome is clinically characterized by the Lenk's triad
- acute flank pain
- flank mass
- hypovolemic shock
Haemorrhage in the perinephric space, often with a primary lesion seen within the kidney e.g. angiomyolipoma, renal cell carcinoma.
Treatment and prognosis
If the haemorrhage is self limiting and the patient is responsive to fluid resuscitation, the patient can be managed conservatively. Angiographic selective embolisation may be pursued in haemodynamically stable patients. In haemodynamically unstable patients, emergent nephrectomy (partial or total) is often required 3.
History and etymology
It is named after the German physician Carl Reinhold August Wunderlich.
- 1. Sparks D, Chase D, Thomas D et-al. The Wunderlich's syndrome secondary to massive bilateral angiomyolipomas associated with advanced tuberous sclerosis. Saudi J Kidney Dis Transpl. 2011;22 (3): 534-7. Saudi J Kidney Dis Transpl (link) - Pubmed citation
- 2. Katabathina VS, Katre R, Prasad SR et-al. Wunderlich syndrome: cross-sectional imaging review. J Comput Assist Tomogr. 35 (4): 425-33. doi:10.1097/RCT.0b013e3182203c5e - Pubmed citation
- 3. Morgentaler A, Belville JS, Tumeh SS et-al. Rational approach to evaluation and management of spontaneous perirenal hemorrhage. Surg Gynecol Obstet. 1990;170 (2): 121-5. - Pubmed citation