Computed Tomography Findings in Wunderlich Syndrome

Abstract

Background: Wunderlich syndrome (WS) is defined as renal/perirenal haemorrhage in the absence of trauma. Causative factors include neoplasms, vascular abnormalities, cystic kidney diseases, and coagulation disorders. Computed tomography (CT) is the diagnostic method of choice in the diagnosis of WS. We aimed to investigate CT findings, aetiologies, demographic features, and treatment outcomes in a group of patients diagnosed with WS. Methods: We retrospectively reviewed 113 patients found to have renal-perirenal hematoma on CT between January 2015 and January 2020, and excluded 101 cases with a history of trauma or renal biopsy. The remaining 12 patients constituted the study group. Results: Five (41.7%) of the 12 patients included in the study were female and seven (58.3%) were male. The mean age was 53.2 years (range, 7-81). CT revealed mass lesions in seven (58.3%), a pseudoaneurysm in two (16.7%), and renal vein thrombosis in one (8.3%) patient. Two of the mass lesions (28.6%) detected on CT were angiomyolipomas, one (14.3%) was a haemorrhagic cyst in a patient with adult polycystic kidney disease, and four (57.1%) were solid mass lesions. Three of the four patients with masses were surgically treated. All pseudoaneurysms, the single inoperable solid mass, and one of the angiomyolipomas were treated angiographically. Conclusion: WS is an acute urological emergency with multiple possible aetiologies, some of which are more likely to require surgical management. CT is important in the diagnosis and management of the syndrome to identify haemodynamically unstable cases in need of immediate intervention.