Wunderlich syndrome – report of a rare case with comments on clinical implications
DOI:
https://doi.org/10.15584/ejcem.2024.3.14Keywords:
angiomiolipoma, flank pain, renal hematoma, spontaneous renal hemorrhage, Wunderlich syndromeAbstract
Introduction and aim. Spontaneous renal hemorrhage, known as Wunderlich syndrome, is a rare clinical condition that occurs without any history of trauma. The most common causes of this syndrome are both benign and malignant renal tumors. The treatment strategy is determined based on the patient’s hemodynamic stability.
Description of the case. We report a case where a patient was admitted to the emergency department experiencing persistent pain in the right flank for three days. A diagnosis of spontaneous renal hemorrhage, secondary to an angiomyolipoma, was established through CT imaging. In this case study, we detail the diagnostic process and management of a patient who, due to the absence of hemodynamic instability, did not require surgical intervention. Instead, the patient was monitored and managed with conservative treatment.
Conclusion. This case highlights the importance of prompt diagnosis, implementation of appropriate treatment, and the relevance of active follow-up in hemodynamically stable patients receiving conservative treatment.
Downloads
References
Wunderlich CR. Handbuch der Pathologie und Therapie. Stuttgart: Ebner and Seubert. 2nd ed. 1856.
Parmar N, Langdon J, Kaliannan K, Mathur M, Guo Y, Mahalingam S. Wunderlich Syndrome: Wonder What It Is. Curr Probl Diagn Radiol. 2022;51(2):270-281. doi: 10.1067/j.cpradiol.2020.12.002
Ramirez-Limon DA, Gonzaga-Carlos N, Angulo-Lozano JC, Miranda-Symes O, Virgen-Gutierrez F. Wunderlich Syndrome Associated With Angiomyolipomas. Cureus. 2022;14(4): e23861. doi: 10.7759/cureus.23861
Riley DS, Barber MS, Kienle GS, et al. CARE guidelines for case reports: explanation and elaboration document. J Clin Epidemiol. 2017;89:218-235. doi: 10.1016/j.jclinepi.2017.04.026
Kim JW, Kim JY, Ahn ST, et al. Spontaneous perirenal hemorrhage (Wunderlich syndrome): An analysis of 28 cases. Am J Emerg Med. 2019;37(1):45-47. doi: 10.1016/j.ajem.2018.04.045
Albi G, del Campo L, Tagarro D. Wünderlich’s Syndrome: Causes, Diagnosis and Radiological Management. Clin Radiol. 2002;57(9):840-845. doi: 10.1053/crad.2002.0981
Katabathina VS, Katre R, Prasad SR, Surabhi VR, Shanbhogue AKP, Sunnapwar A. Wunderlich Syndrome. J Comput Assist Tomogr. 2011;35(4):425-433. doi: 10.1097/RCT.0b013e3182203c5e
Bayraktar N. Wunderlich syndrome secondary to ureteropelvic junction obstruction. Ulus Travma Acil Cerrahi Derg. 2023;29(5):641-643. doi: 10.14744/tjtes.2022.54502
Swaminathan N, Sedhom R, Shahzad A, Azmaiparashvili Z. Post-partum occurrence of Wunderlich syndrome and microangiopathic haemolytic anaemia (MAHA): a case report. J Community Hosp Intern Med Perspect. 2021;11(2):277-279. doi: 10.1080/20009666.2021.1883812
Medda M, Picozzi S, Bozzini G, Carmignani L. Wunderlich′s syndrome and hemorrhagic shock. J Emerg Trauma Shock. 2009;2(3):203. doi: 10.4103/0974-2700.55346
Samuels JA. Treatment of Renal Angiomyolipoma and Other Hamartomas in Patients with Tuberous Sclerosis Complex. Clinical Journal of the American Society of Nephrology. 2017;12(7):1196-1202. doi: 10.2215/CJN.08150816
García-Chairez LR, Montelongo-Rodríguez FA, Moreno-Arquieta IA, Ayala MM, Gutierrez-González A. Unusual Presentation of Wünderlich Syndrome. Ochsner Journal. 2022;22(3):273-276. doi :10.31486/toj.21.0120
Jia Y, Gao J. Spontaneous perirenal hemorrhage (Wunderlich syndrome) in the fetus: a case report. J Med Case Rep. 2023;17(1):204. doi: 10.1186/s13256-023-03867-4
Vercelli A, Pagani L, Christodoulakis K, et al. Hypovolemic shock due to Wunderlich syndrome (spontaneous renal haemorrhage): a case report and literature review. Acta Biomedica. 2023;94(3):e2023073. doi: 10.23750/abm.v94i3.14087
Simkins A, Maiti A, Cherian S V. Wunderlich Syndrome. Am J Med. 2017;130(5):e217-e218. doi: 10.1016/j.amjmed.2016.11.031
Grubb SM, Stuart JI, Harper HM. Sudden onset flank pain: Spontaneous renal rupture. Am J Emerg Med. 2017;35(11):1787e1-1787e3. doi: 10.1016/j.ajem.2017.07.095
Ahn T, Roberts MJ, Navaratnam A, Chung E, Wood S. Changing etiology and management patterns for spontaneous renal hemorrhage: a systematic review of contemporary series. Int Urol Nephrol. 2017;49(11):1897-1905. doi: 10.1007/s11255-017-1694-8
Cubillos JD, Mejia DR, Cañas EE, Serrano J, Casas O. A Subacute Presentation of Wunderlich Syndrome in a Young Woman: A Case Report. Cureus. 2023;15(7):e41385. doi: 10.7759/cureus.41385
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 European Journal of Clinical and Experimental Medicine

This work is licensed under a Creative Commons Attribution 4.0 International License.
Our open access policy is in accordance with the Budapest Open Access Initiative (BOAI) definition: this means that articles have free availability on the public Internet, permitting any users to read, download, copy, distribute, print, search, or link to the full texts of these articles, crawl them for indexing, pass them as data to software, or use them for any other lawful purpose, without financial, legal, or technical barriers other than those inseparable from having access to the Internet itself.
All articles are published with free open access under the CC-BY Creative Commons attribution license (the current version is CC-BY, version 4.0). If you submit your paper for publication by the Eur J Clin Exp Med, you agree to have the CC-BY license applied to your work. Under this Open Access license, you, as the author, agree that anyone may download and read the paper for free. In addition, the article may be reused and quoted provided that the original published version is cited. This facilitates freedom in re-use and also ensures that Eur J Clin Exp Med content can be mined without barriers for the research needs.




