Renal angiomyolipoma with hemorrhage - Wunderlich syndrome
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Acute severe flank pain with fainting and confusion. on examination, the patient showed signs of shock with hypotension and tachycardia.
Ultrasound study shows a right renal fossa sizable echogenic mass lesion with a peripheral component of turbid septated fluid-like echogenicity.
Incidental gallbladder stone.
CT study shows right renal/ perirenal space sizable fat-containing exophytic mass lesion of complex density measures 10x10x15 cm, shows a large fatty component, with a peripheral soft tissue-like density seen predominantly medially mostly representing clotted blood. An internal localized area of fat-blood level and perinephric fat stranding is also noted. The right kidney appears displaced and compressed with a shaggy irregular outline more prominent at its upper and mid zones.
Right hepatic lobe segment VII subcapsular small focal lesion measures 25 mm mostly a hemangioma.
Gallbladder stone and right mild pleural effusion.
Wunderlich syndrome is a rare condition in which spontaneous non-traumatic renal hemorrhage occurs into the subcapsular and perirenal spaces. It is clinically characterized by Lenk's triad; acute flank pain, flank mass, and hypovolemic shock.
After resuscitation, this patient was transferred for emergency embolization.
Ultrasound contribution by Dr. Somia Elbadawy