#1446

Idiopathic bilateral renal hemorrhage: Wunderlich Syndrome

S. Muthanandam¹, H. Sevenathan¹, L. Lechmiannandan¹, K. Ramasamy¹

¹Hospital Raja Permaisuri Bainun, Urology Department, Ipoh, Malaysia

Introduction:

Wunderlich syndrome (WS) is a rare but life-threatening condition characterised by spontaneous, non-traumatic renal haemorrhage confined to the perirenal and subcapsular space. It is typically accompanied by acute flank pain, a flank mass, and hypovolemic shock, known as Lenk's triad. WS can be classified into neoplastic and non-neoplastic origins, with up to 60% of cases caused by benign neoplasms such as angiomyolipoma and malignancies such as renal cell carcinoma. Non-neoplastic causes include vasculitis, renal artery aneurysm, arteriovenous malformation, nephritis, coagulopathy, and infectious processes. In this report, we present the case of a previously healthy 56-year-old man who developed fever, left flank pain, and hematuria of 2-week duration during a pilgrimage in the Middle East. A vague left flank mass with tenderness was found upon abdominal examination. Contrast-enhanced CT revealed bilateral perinephric haemorrhage; left more than right, without evidence of abnormal vascularity or renal mass, leading to a diagnosis of WS likely caused by an infection from recent travel. A repeated CT scan showed no significant changes, and the patient remained hemodynamically stable, leading to conservative treatment. Percutaneous drainage of the collection was planned for the patient.

Material and methods:

Patient’s data was collected through the analysis of official records, including renal functional evaluations, ultrasound, and CT imaging.