Wunderlich Syndrome: Imaging, Intervention, and Impact

Abstract

Wunderlich syndrome (WS) refers to spontaneous renal or perinephric hemorrhage occurring in the absence of known trauma. WS can be due to neoplasms, vascular diseases, cystic rupture, coagulopathies and infections. Here, we describe a case of WS in a 28 year old man who presented with history of left flank pain with a palpable tender mass for one week duration. Imaging showed a  large predominantly exophytic enhancing mass with a large fat density component in the left kidney and blood density in perinephric space suggestive of  Angiomyolipoma (AML) with acute bleed. Trans arterial embolization (TAE) of the lesion was done since the patient was hemodynamically unstable. On follow up after one month, patient was symptomatically better and USG showed significant reduction in size of the mass. Trans arterial embolization of AML is a minimally invasive, nephron sparing procedure that offers superior renal function preservation, lower morbidity and shorter hospital stays.