A Case of Spontaneous Renal Haemorrhage (Wunderlich Syndrome) in an Anticoagulated Patient
  • Manuela Giovini
    Intermediate Care Unit, Emergency Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
  • Erika Poggiali
    Emergency Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
  • Piervito Zocchi
    Emergency Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
  • Esterina Bianchi
    Radiology Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
  • Elio Antonucci
    Intermediate Care Unit, Emergency Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
  • Mario Barbera
    Intermediate Care Unit, Emergency Department, Guglielmo da Saliceto Hospital, Piacenza, Italy

Keywords

Spontaneous renal haemorrhage, renal haematoma, Wunderlich syndrome, anticoagulation, flank pain, contrast-enhanced computed tomography

Abstract

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.

VIEW THE ENTIRE ARTICLE

References

  • Katabathina VS, Katre R, Prasad SR, Surabhi VR, Shanbhogue AK, Sunnapwar A. Wunderlich syndrome: cross-sectional imaging review. J Comput Assist Tomogr 2011;35(4):425–433.
  • Mabjeesh NJ, Matzkin H. Spontaneous subcapsular renal hematoma secondary to anticoagulant therapy. J Urol 2001;165(4):1201.
  • Ferrando F, Budía A, Mira Y, Vayá A, Aznar J. Spontaneous renal subcapsular hematoma in an anticoagulated patient. Clin Appl Thromb Hemost 2006;12(1):89–92.
  • Zhang JQ, Fielding JR, Zou KH. Etiology of spontaneous perirenal hemorrhage: a meta-analysis. J Urol 2002;167(4):1593–1596.
  • Albi G, del Campo L, Tagarro D. Wünderlich's syndrome: causes, diagnosis and radiological management. Clin Radiol 2002;57(9):840–845.
  • Parmar N, Langdon J, Kaliannan K, Mathur M, Guo Y, Mahalingam S. Wunderlich syndrome: wonder what it is. Curr Probl Diagn Radiol 2021;9:S0363-0188(21)00016-5.
  • 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.
  • Chan YC, Morales JP, Reidy JF, Taylor PR. Management of spontaneous and iatrogenic retroperitoneal haemorrhage: conservative management, endovascular intervention or open surgery? Int J Clin Pract 2008;62(10):1604–1613.
  • Views: 1200
    HTML downloads: 187
    PDF downloads: 540


    Published: 2022-04-01
    Issue: 2022: Vol 9 No 4 (view)


    How to cite:
    1.
    Giovini M, Poggiali E, Zocchi P, Bianchi E, Antonucci E, Barbera M. A Case of Spontaneous Renal Haemorrhage (Wunderlich Syndrome) in an Anticoagulated Patient. EJCRIM 2022;9 doi:10.12890/2022_003269.

    Most read articles by the same author(s)