Wunderlich’s Syndrome, or Spontaneous Retroperitoneal Hemorrhage, in a Patient with Tuberous Sclerosis and Bilateral Renal Angiomyolipoma

Santos, Sara Catarino; Duarte, Liliana; Valério, F; Constantino, J.; Pereira, Jorge; Casimiro, Carlos

doi:10.12659/ajcr.905975

Cited by 3 publications

(1 citation statement)

References 14 publications

(40 reference statements)

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“…The main etiologies reported are tumors, with malignant tumors such as adenocarcinoma, followed by angiomyolipoma, being the most common. Angiomyolipoma can be found either isolated or associated with tuberous sclerosis, where they usually present at younger ages, reaching larger sizes, multifocal, and bilateral [ 7 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Subcapsular Renal Hematoma as Cause of Hypovolemic Shock in a Chronic Hemodialysis Patient

Bermudez-Gonzalez,

Rodríguez-Encinas,

Beverido-Florido

et al. 2023

Case Reports in Radiology

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Section: Discussionmentioning

confidence: 99%

Spontaneous Subcapsular Renal Hematoma as Cause of Hypovolemic Shock in a Chronic Hemodialysis Patient

Bermudez-Gonzalez,

Rodríguez-Encinas,

Beverido-Florido

et al. 2023

Case Reports in Radiology

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Spontaneous Retroperitoneal Bleeding in a Patient with Primary Antiphospholipid Syndrome on Aspirin

Ιωάννου

Alexakis

2018

Case Reports in Emergency Medicine

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Retroperitoneal bleeding is a rare and difficult to diagnose condition, defined as bleeding in the retroperitoneal space without associated trauma or iatrogenic manipulation. It has been associated with hematologic diseases and malignancies and is more common in patients receiving systemic anticoagulation. A 50-year-old man on aspirin presented with abdominal pain. Physical examination revealed abdominal tenderness and a palpable mass at the left abdominal area. An abdominal CT revealed a spontaneous retroperitoneal hematoma due to bleeding of an intraparenchymal branch of the left renal artery. The patient underwent left nephrectomy in order to control the bleeding. Pathology of the kidney showed evidence of acute and chronic microangiopathy, renal artery stenosis, and renal vein thrombosis. Further work-up led to diagnosis of primary antiphospholipid syndrome. Treatment of spontaneous retroperitoneal bleeding varies from conservative in hemodynamically stable patients to invasive or even surgery in hemodynamically unstable patients. In our case, open surgery was performed due to the rapidly deteriorating patient's condition and the inability to embolize the bleeding vessel by interventional radiology. Physicians should always think of retroperitoneal bleeding in patients presenting with abdominal pain and signs of hypovolemia, especially if they have a bleeding disorder or receive anticoagulants or antiplatelets.

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The Comparison of the Results of Ultrasound, CT and MRI in the Diagnosis of Angiomyolipoma Kidneys, Including Complicated by Development of the Syndrome Wunderlich

Vorotynceva

Gaidukova

2021

Medical Radiology and Radiation Safety

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Purpose: Analysis the effectiveness of various methods of radiation studies for the detection of renal angiomyolipomas (RAMLs), including the diagnosis of Wunderlich syndrome. Material and methods: The analysis of the results of a comprehensive radiation study of the kidneys of 115 patients who were diagnosed with focal formation in primary renal ultrasound was carried out. Further, of those 115 people, 47 patients underwent MRI of the kidneys, 60 patients – CT and 8 patients complex MRI+CT, including contrast-enhanced vasculature. Results and discussion: Angiomyolipoma was detected by ultrasound in 38 (33.0 %) of 115 patients, and according to MRI and CT in total in 27 (23.5 %) patients. Coincidence of ultrasound findings and MRI and CT results was in 18 patients. Consequently, the sensitivity of ultrasound in the diagnosis of RAML was compared with MRI – 45 %; when compared with CT – 42.8 %, and specificity – 55 % and 57.1 %, respectively. Reliable signs of RAML in ultrasound were hyperechogenic homogeneous structure, clear smooth contours of the formation. The rounded form of education is statistically unreliable. Statistically significant characteristics of RAML in magnetic resonance imaging are heterogeneous structure, heterogeneous hyperintense MR-signal on T1 and heterogeneously hypointensity on T2-weighted images, always uniformly hypo-Fs for T1 / T2 Fs, with hypo clear boundary between education and renal parenchyma on T1 in the opp phase. Reliable signs of RAML with CT are non-uniform structure of education, with non-uniform x-ray density. Conclusion: Ultrasound diagnosis is necessary for screening kidney disease, while CT and MRI have greater sensitivity and specificity to determine the nature of focal formation. With the development of Wunderlich’s syndrome, a complex of radiological methods, including ultrasound, MRI and CT, allows to diagnose the cause of hemorrhage, as well as to obtain complete diagnostic information necessary for the surgeon to plan treatment.

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Wunderlich’s Syndrome, or Spontaneous Retroperitoneal Hemorrhage, in a Patient with Tuberous Sclerosis and Bilateral Renal Angiomyolipoma

Cited by 3 publications

References 14 publications

Spontaneous Subcapsular Renal Hematoma as Cause of Hypovolemic Shock in a Chronic Hemodialysis Patient

Spontaneous Subcapsular Renal Hematoma as Cause of Hypovolemic Shock in a Chronic Hemodialysis Patient

Spontaneous Retroperitoneal Bleeding in a Patient with Primary Antiphospholipid Syndrome on Aspirin

The Comparison of the Results of Ultrasound, CT and MRI in the Diagnosis of Angiomyolipoma Kidneys, Including Complicated by Development of the Syndrome Wunderlich

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