Presentation
The patient presented to the emergency department with right flank pain.
Patient Data
There is a perirenal collection measuring about 1.8 cm in thickness seen mainly at the lower pole of right kidney and appears minimally hyperechoic suggesting perirenal hematoma with surrounding turbid free fluid (proved by CT to be retroperitoneal hematoma) as well as a renal well-defined rounded hyperechoic lesion with heterogenous hypoechoic areas and acoustic shadowing seen within the kidney measuring roughly about 7.8 x 8 cm; features suggest a ruptured renal lesion (mostly angiomyolipoma), for urgent surgical evaluation.
Right-sided retroperitoneal hemorrhage and perirenal hematoma measuring about 7.9 x 5.6 x 5 cm continuous with a renal fat-containing lesion with internal blood-density component measuring about 7 x 5.5 x 7.7 cm (AP, RL, CC); features mostly suggest right-sided huge angiomyolipoma complicated by rupture and large retroperitoneal hematoma, for urgent surgical evaluation.
Incidental note of:
A stone in the lower pole of the left kidney.
A non-enhancing fluid-density lesion in the upper pole of the left kidney, suggests a cyst.
Two dense gallbladder stones.
Case Discussion
This is a case of Wunderlich syndrome, which is an uncommon disorder of spontaneous renal hemoarrhage into the subcapsular and perirenal spaces.
The large quantity of fat within the underlying mass indicates angiomyolipoma. The risk of hemorrhage is related to the size of the tumor.
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