Renal angiomyolipoma: with Wunderlich syndrome
Presented to the emergency department with sudden onset of pain in left flank, back and abdomen. On examination, she appeared in shock with cool extremities. Her abdomen was soft but tender generally with guarding in upper left quadrant. Vital signs: HR: 110, RR: 30 She had a negative FAST scan.
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There is a large left retroperitoneal hematoma with active bleeding from a left renal tumor measuring 9 x 7 x 6.5 cm. The tumor has a large fatty component with abnormal vascularity,compatible with a large angiomyolipoma. Hemoperitoneum is also noted adjacent to spleen
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This patient underwent embolization of the bleeding tumor by the interventional radiologist. She was admitted to ITU following this and received three units of red cells. The follow-up CT scan demonstrated a successful embolization procedure with a resolving retroperitoneal hematoma.
Wunderlich syndrome is a rare cause of intra-abdominal hemorrhagic shock. Due to the retroperitoneal extravasation of blood, the FAST scan can be negative and falsely reassuring. Furthermore, as in this instance, the patient may have no previous medical history prior to the acute presentation with shock.