From the Guidelines
The term for spontaneous rupture of a renal mass resulting in a subcapsular hematoma is Wunderlich syndrome. This rare condition is characterized by the sudden onset of bleeding from a renal mass into the subcapsular space, creating a hematoma that is contained by the renal capsule. Wunderlich syndrome typically presents with the classic triad of acute flank pain, palpable flank mass, and hypovolemic shock, though not all patients exhibit all three symptoms. The most common underlying causes include renal tumors (particularly angiomyolipoma and renal cell carcinoma), vascular diseases like polyarteritis nodosa, and less frequently, infections or cystic diseases of the kidney. Diagnosis is usually confirmed through imaging studies such as CT scan or ultrasound, which can visualize the hematoma and potentially identify the underlying cause. Treatment depends on the patient's hemodynamic stability and may range from conservative management with close monitoring to emergency interventional procedures or surgery in severe cases, as suggested by recent guidelines 1.
Some key points to consider in the management of Wunderlich syndrome include:
- The importance of prompt diagnosis and treatment to prevent further complications and improve outcomes 1
- The role of imaging studies, such as CT scan and ultrasound, in confirming the diagnosis and identifying the underlying cause of the hematoma 1
- The need for individualized treatment approaches, taking into account the patient's hemodynamic stability, underlying cause of the hematoma, and other relevant factors 1
- The potential benefits and risks of different treatment options, including conservative management, interventional procedures, and surgery, and the importance of careful consideration of these factors in making treatment decisions 1.
Overall, Wunderlich syndrome is a rare but potentially life-threatening condition that requires prompt and effective management to prevent further complications and improve outcomes.
From the Research
Definition of the Process
- The term for spontaneous rupture of a renal mass resulting in a subcapsular hematoma is Wunderlich syndrome 2, 3, 4, 5, 6.
Characteristics of Wunderlich Syndrome
- Wunderlich syndrome is a rare clinical syndrome characterized by an acute onset of spontaneous renal hemorrhage into the subcapsular, perirenal, and/or pararenal spaces, without a history of antecedent trauma 2.
- The classic symptom complex of flank pain, a flank mass, and hypovolemic shock is referred to as the Lenk triad, seen in a small subset of patients 2, 3, 5.
Causes of Wunderlich Syndrome
- Renal neoplasms, such as angiomyolipomas and clear cell renal cell carcinomas, contribute to approximately 60%-65% of all cases of Wunderlich syndrome 2.
- Renal vascular diseases, including aneurysms or pseudoaneurysms, arteriovenous malformations or fistulae, renal vein thrombosis, and vasculitis syndromes, account for 20%-30% of cases 2.
- Other rare causes of Wunderlich syndrome include renal infections, cystic diseases, calculi, kidney failure, and coagulation disorders 2, 3, 4.