Spontaneous perirenal hemorrhage (Wunderlich syndrome): An analysis of 28 cases

Jong Wook Kim, Jung Youn Kim, Sun Tae Ahn, Tae Yong Park, Mi-Mi Oh, Du Geon Moon, Hong Seok Park

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Introduction: This study aimed to analyze the characteristics, etiology, and treatment of a series of patients with spontaneous perirenal hemorrhage (Wunderlich syndrome [WS]). Methods: 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. Results: 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. Conclusion: 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 hemodynamic instability.

Original languageEnglish
JournalAmerican Journal of Emergency Medicine
DOIs
Publication statusAccepted/In press - 2018 Jan 1

Fingerprint

Hemorrhage
Renal Cell Carcinoma
Kidney
Hematoma
Shock
Tomography
Cystic Kidney Diseases
Blood Pressure
Flank Pain
Angiomyolipoma
Pyelonephritis
Nephrectomy
Sarcoma
Hospital Emergency Service
Cysts
Neoplasms
Hospitalization
Emergencies
Hemodynamics
Therapeutics

Keywords

  • Perirenal hemorrhage
  • Renal tumor
  • Wunderlich syndrome

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Spontaneous perirenal hemorrhage (Wunderlich syndrome) : An analysis of 28 cases. / Kim, Jong Wook; Kim, Jung Youn; Ahn, Sun Tae; Park, Tae Yong; Oh, Mi-Mi; Moon, Du Geon; Park, Hong Seok.

In: American Journal of Emergency Medicine, 01.01.2018.

Research output: Contribution to journalArticle

@article{18f8bec2ee13451f86caa7fd0d311415,
title = "Spontaneous perirenal hemorrhage (Wunderlich syndrome): An analysis of 28 cases",
abstract = "Introduction: This study aimed to analyze the characteristics, etiology, and treatment of a series of patients with spontaneous perirenal hemorrhage (Wunderlich syndrome [WS]). Methods: 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. Results: 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. Conclusion: 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 hemodynamic instability.",
keywords = "Perirenal hemorrhage, Renal tumor, Wunderlich syndrome",
author = "Kim, {Jong Wook} and Kim, {Jung Youn} and Ahn, {Sun Tae} and Park, {Tae Yong} and Mi-Mi Oh and Moon, {Du Geon} and Park, {Hong Seok}",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.ajem.2018.04.045",
language = "English",
journal = "American Journal of Emergency Medicine",
issn = "0735-6757",
publisher = "W.B. Saunders Ltd",

}

TY - JOUR

T1 - Spontaneous perirenal hemorrhage (Wunderlich syndrome)

T2 - An analysis of 28 cases

AU - Kim, Jong Wook

AU - Kim, Jung Youn

AU - Ahn, Sun Tae

AU - Park, Tae Yong

AU - Oh, Mi-Mi

AU - Moon, Du Geon

AU - Park, Hong Seok

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Introduction: This study aimed to analyze the characteristics, etiology, and treatment of a series of patients with spontaneous perirenal hemorrhage (Wunderlich syndrome [WS]). Methods: 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. Results: 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. Conclusion: 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 hemodynamic instability.

AB - Introduction: This study aimed to analyze the characteristics, etiology, and treatment of a series of patients with spontaneous perirenal hemorrhage (Wunderlich syndrome [WS]). Methods: 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. Results: 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. Conclusion: 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 hemodynamic instability.

KW - Perirenal hemorrhage

KW - Renal tumor

KW - Wunderlich syndrome

UR - http://www.scopus.com/inward/record.url?scp=85047068273&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85047068273&partnerID=8YFLogxK

U2 - 10.1016/j.ajem.2018.04.045

DO - 10.1016/j.ajem.2018.04.045

M3 - Article

AN - SCOPUS:85047068273

JO - American Journal of Emergency Medicine

JF - American Journal of Emergency Medicine

SN - 0735-6757

ER -