Wunderlich Syndrome: Wonder What It Is

Parmar, Nishita; Langdon, Jonathan; Kaliannan, Krithica; Mathur, Mahan; Guo, Yang; Mahalingam, Sowmya

doi:10.1067/j.cpradiol.2020.12.002

Cited by 19 publications

(21 citation statements)

References 49 publications

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“…Wunderlich syndrome was first described by the German physician Carl Wunderlich in 1856 2–5 7 8 10 12. The classic presentation of Lenk’s triad consisting of flank pain, flank mass and hypovolaemic shock described in literature is only present in 20%–30% of patients 11.…”

Section: Discussionmentioning

confidence: 99%

“…Wunderlich syndrome is characterised by atraumatic spontaneous haemorrhage in the subcapsular or perinephric space 1–5. The classical presentation described in literature is that of Lenk’s triad—acute flank pain, flank mass and hypovolaemic shock 3 5–9. It is a rare condition with an incidence between 0.07% and 0.3% in the general population 10.…”

Section: Introductionmentioning

confidence: 99%

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Wunderlich syndrome in a patient with pyelonephritis

Chia,

Chong,

Yong

et al. 2024

BMJ Case Rep

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An elderly female patient with left pyelonephritis developed worsening left flank pain, hypotension and a drop in haemoglobin (Hb) from 97 g/L to 67g/L on the third day of her admission. There was no recent trauma, history of coagulopathy or risk factors for renal malignancy or vascular disease.A contrasted CT scan of the kidneys revealed a 3.8 cm left renal subcapsular haematoma with no active contrast extravasation. Her atraumatic subcapsular haematoma fulfils two out of three clinical features of Lenk’s triad (acute flank pain, hypovolaemic shock), suggestive of Wunderlich syndrome. Urine and blood cultures grewKlebsiella pneumoniaeand she was managed conservatively with culture-directed antibiotics, fluids and blood products.Wunderlich syndrome is a rare complication of pyelonephritis and should be considered in patients with pyelonephritis who develop acute severe flank pain, Hb drop and haemodynamic instability. Appropriate medical and surgical therapies need to be instituted early to ensure good outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Wunderlich syndrome in a patient with pyelonephritis

Chia,

Chong,

Yong

et al. 2024

BMJ Case Rep

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“…RCC are less common but are malignant [5] . In case of tumour, enhanced-contrast CT scan of the abdomen is the gold standard to identify the cause of haemorrhage and active bleeding [6] . Vascular diseases, infections, coagulopathies and cyst rupture must always be investigated and excluded [6] .…”

Section: Discussionmentioning

confidence: 99%

“…In case of tumour, enhanced-contrast CT scan of the abdomen is the gold standard to identify the cause of haemorrhage and active bleeding [6] . Vascular diseases, infections, coagulopathies and cyst rupture must always be investigated and excluded [6] . Some cases are idiopathic but are probably due to the rupture of small cysts or a small extrarenal vessel, infection, inflammation or passed calculi.…”

Section: Discussionmentioning

confidence: 99%

A Case of Spontaneous Renal Haemorrhage (Wunderlich Syndrome) in an Anticoagulated Patient

Giovini

Poggiali

Zocchi

et al. 2022

European Journal of Case Reports in Internal Medicine

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Spontaneous renal haemorrhage is a rare but severe condition known as Wunderlich syndrome (WS). The classic presentation includes sudden-onset flank pain, a palpable flank mass and hypovolaemic shock (Lenk’s triad). WS can be due to neoplasms, vascular diseases, cystic rupture, coagulopathies and infections. A contrast-enhanced CT scan of the abdomen is mandatory for diagnosis. Surgery is reserved for haemodynamically unstable patients and those with neoplastic disease. We describe a case of WS in an anticoagulated patient with chronic atrial fibrillation, diabetes mellitus type 2 and hypertension, who developed acute renal failure and severe anaemia, that completely resolved with conservative treatment and discontinuation of anticoagulation therapy.

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“…This did not make as sure that the bleeding site was not present. The literature reports that if the CT scan, followed by angiography, do not reveal the bleeding source, a CT scan should be repeated at the time distance, because it is obvious that if the hemorrhage is huge, an eventual renal cell carcinoma or angiomyolipoma or other eventual renal bleeding sites as renal cysts, could be seen just after the resorption of the hematoma has occurred [13]. That was also proved, not just in cases of renal angiomyolipoma or clear cell carcinoma, but also in rare cases of renal sarcoma presenting the Wunderlich syndrome [14].…”

Section: Discussionmentioning

confidence: 99%

A rare case of spontaneous perirenal hemorrhage - Wunderlich syndrome

Arandjelovic¹,

Lai²,

Milani³

2021

Srp Arh Celok Lek

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Introduction. Spontaneous perirenal hemorrhage or Wunderlich syndrome represents a rare entity in the urological settings. The vast majority of the causes are represented by angiomyolipoma and renal cell carcinoma. In other cases, the vascular abnormalities, polycystic kidneys, polyarthritis nodosa or pyelonephritis could represent the cause of perirenal bleeding. The treatment depends on clinical parameters at the presentation as on the presence of eventual renal malignancies. Our goal was to present a rare case of a healthy men who presented the idiopathic Wunderlich syndrome. Case outline. We present the case of 50 years old patients with spontaneous perirenal hemorrhage which was not due to any defined cause even after sixth months follow-up. Conclusion. In some rare cases of perirenal bleeding the cause cannot be defined at the presentation, even with today?s very developed radiologic imaging and methods. Thus, it is important to be aware of the fact that in those cases, the longer follow up is needed, knowing that the presence of perirenal hematoma can always obscure the real diagnosis. Sometimes, even in the cases where the proper follow-up has been done, the real cause of the bleeding remains unknown.

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Wunderlich Syndrome: Wonder What It Is

Cited by 19 publications

References 49 publications

Wunderlich syndrome in a patient with pyelonephritis

Wunderlich syndrome in a patient with pyelonephritis

A Case of Spontaneous Renal Haemorrhage (Wunderlich Syndrome) in an Anticoagulated Patient

A rare case of spontaneous perirenal hemorrhage - Wunderlich syndrome

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