Wunderlich syndrome

Changed by Ayush Goel, 27 Dec 2014

Updates to Article Attributes

Body was changed:

Show markup changes

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~~: 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.

History and etymology

It is named after the German physician Carl Reinhold August Wunderlich

Image 1 CT (C+ arterial phase) ( create )

ADVERTISEMENT: Supporters see fewer/no ads

{"current_user":null,"inclusions":[{"imageId":9950127,"studyId":34019,"caseSlug":"renal-angiomyolipoma-wunderlich-syndrome","caption":"Case 1","thumbnail":"https://prod-images-static.radiopaedia.org/images/9950127/b353ad200534a2bd20c25be6c8c5f8_big_gallery.jpg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":321,"studyId":8803,"caseSlug":"angiomyolipoma-with-haemorrhage","caption":"Case 2","thumbnail":"https://prod-images-static.radiopaedia.org/images/321/fe129d9f2a9be2ef2b411a359f76e0_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":2610011,"studyId":20411,"caseSlug":"renal-haematoma-in-a-patient-with-angiomyolipoma-wunderlich-syndrome","caption":"Case 3","thumbnail":"https://prod-images-static.radiopaedia.org/images/2610011/5c2ff76c43bd0000a1cb405a1ff860580094f5345c70224196a5c011201c69bf_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_unsubstantiated"},{"imageId":7155235,"studyId":29845,"caseSlug":"wunderlich-syndrome-2","caption":"Case 4","thumbnail":"https://prod-images-static.radiopaedia.org/images/7155235/cb904e3019807ce97c0f8c9f7f3226_big_gallery.jpg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":54878902,"studyId":105615,"caseSlug":"wunderlich-syndrome-6","caption":"Case 5","thumbnail":"https://prod-images-static.radiopaedia.org/images/54878902/110161_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":55863840,"studyId":110957,"caseSlug":"renal-angiomyolipoma-with-haemorrhage-wunderlich-syndrome","caption":"Case 6 ","thumbnail":"https://prod-images-static.radiopaedia.org/images/55863840/1382936ffe4a1f628f9da6c568347d6b1ebbcaf707d4cc553ec77145c05d48ea_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":64543981,"studyId":144879,"caseSlug":"wunderlich-syndrome-13","caption":"Wunderlich syndrome","thumbnail":"https://prod-images-static.radiopaedia.org/images/64543981/c6a94d02eb7fc1cf19d052f0b3d4cc0930d626fb03b9e51e6b119612346de7f2_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"probable"},{"imageId":59895376,"studyId":127683,"caseSlug":"wunderlich-syndrome-11","caption":"Case 7","thumbnail":"https://prod-images-static.radiopaedia.org/images/59895376/f5c16813ad9294abcc0eba4d83e09898ea80db8a1cb696c1e2d856d8138ac2e5_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"probable"},{"imageId":61555420,"studyId":133754,"caseSlug":"wunderlich-syndrome-12","caption":"Case 8","thumbnail":"https://prod-images-static.radiopaedia.org/images/61555420/0ee052d464b312fd1af5000ee1a57063247d824b2c556474e6960437a8fe1b32_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":64045711,"studyId":143964,"caseSlug":"wunderlich-syndrome-with-pseudoaneurysm-due-to-angiomyolipoma-rupture","caption":"Case 9: due to angiomyolipoma rupture","thumbnail":"https://prod-images-static.radiopaedia.org/images/64045711/e3d3fcb4e1e1b1efe3a9b528e64644d9a50914eae1f65c823c29f765a1472f22_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"}],"ddx_inclusions":[],"lang":"us"}