SHM Converge Scientific Abstract ePoster Gallery-Wunderlich Syndrome: Spontaneous Atraumatic Rupture of Renal Cyst

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This case describes a 60-year-old man with a known renal cyst who presented with sudden, severe right upper quadrant pain radiating to the right flank while traveling, without trauma, fever, or gastrointestinal symptoms. Exam showed focal RUQ tenderness, and initial labs revealed leukocytosis and a hemoglobin drop from his baseline (10.1 from 12). CT abdomen/pelvis with IV contrast demonstrated a ruptured hemorrhagic right renal cyst, but a solid component could not be excluded. Follow-up retroperitoneal ultrasound showed an exophytic hemorrhagic lesion from the lower pole of the right kidney, again raising concern for either a benign hemorrhagic cyst or hemorrhage into a cystic neoplasm.<br /><br />The patient was admitted for observation and close monitoring of vitals and blood counts because spontaneous renal hemorrhage, or Wunderlich syndrome, can progress to hemorrhagic shock. His hemoglobin initially decreased further to 8.8 but then improved to 9.8 without transfusion. MRI was considered to better evaluate for malignancy, since multiphasic CT or MRI is preferred to identify the underlying cause of spontaneous renal hemorrhage, but inpatient MRI was complicated by his ICD and spinal stimulators and was ultimately deferred to outpatient follow-up at the patient’s request.<br /><br />The discussion emphasizes that Wunderlich syndrome is a rare, atraumatic spontaneous renal hemorrhage. Common causes include renal neoplasms, especially angiomyolipoma and renal cell carcinoma, which account for most cases. Other causes include vascular disorders, infections, cystic disease, and stones. Clinicians should maintain a broad differential for sudden flank or upper abdominal pain, especially in patients with known renal cysts, and monitor closely for hemodynamic instability. If patients worsen, interventional radiology embolization or surgery, including nephrectomy, may be required.

Asset Subtitle

Olivia Raihl

Meta Tag

Author List Jacob Zinn, Olivia Raihl

Category Clinical Vignettes

Concept Wunderlich Syndrome

Concept Renal hemorrhage

Concept Renal neoplasm

Concept Computed Tomography

Concept Hemorrhagic Shock

Distinguished Non-Finalist

Presenter Organization University of Pennsylvania

Presenting Author Olivia Raihl

Track Adult

Keywords

Wunderlich syndrome

spontaneous renal hemorrhage

ruptured hemorrhagic renal cyst

right upper quadrant pain

right flank pain

hemoglobin drop

renal cyst

angiomyolipoma

renal cell carcinoma

retroperitoneal ultrasound

Wunderlich Syndrome

Renal hemorrhage

Renal neoplasm

Computed Tomography

Hemorrhagic Shock