This study aimed to analyze the characteristics, etiology, and treatment of a series
of patients with spontaneous perirenal hemorrhage (Wunderlich syndrome [WS]).
We retrospectively reviewed the records of 26 patients hospitalized for WS in a tertiary
urological center between 2011 and 2018. All patients were evaluated for perirenal
hemorrhage observed on computed tomography (CT) in the emergency department. Clinical
variables (age, underlying diseases, symptoms, shock, and hospitalization period),
laboratory test results, and radiological and pathological results were reviewed.
The series included 28 events from 26 patients with a mean follow-up period of 20.2 ± 18.0 months.
Flank pain was most common symptoms (92%). Twelve patients (46%) had visible renal
lesions and associated hematoma and 14 only showed perirenal hematoma. In six patients
with shock (systolic blood pressure < 90 mm Hg), 2 underwent emergency angioembolization.
Twelve patients (46%) underwent exploration and total nephrectomy. In the final diagnosis,
4 cases of renal cell carcinoma, 3 of angiomyolipoma, 4 of simple renal cyst, 2 of
acquired cystic kidney disease, 4 of sarcoma or other malignancy, 4 of chronic pyelonephritis,
and 5 of idiopathic WS were observed. Patient age was associated with prediction of
renal cell carcinoma in the patients with WS.
Renal masses are the main cause of WS, and CT is the diagnostic procedure of choice.
Old age is a possible risk factor for renal cell carcinoma in etiology of WS. Surgical
treatment is preferred in patients diagnosed with renal malignancy and in cases of