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Wunderlich Syndrome: Cross-Sectional Imaging Review

Katabathina, Venkata S. MD*; Katre, Rashmi MD*; Prasad, Srinivasa R. MD; Surabhi, Venkateswar R. MD; Shanbhogue, Alampady K.P. MD*; Sunnapwar, Abhijit MD*

Journal of Computer Assisted Tomography: July-August 2011 - Volume 35 - Issue 4 - p 425-433
doi: 10.1097/RCT.0b013e3182203c5e
Abdominal Imaging

Wunderlich syndrome (WS) is a rare condition characterized by acute onset of spontaneous, nontraumatic renal hemorrhage into the subcapsular and perirenal spaces. Wunderlich syndrome is classically characterized by the Lenk's triad: acute flank pain, flank mass, and hypovolemic shock. However, the clinical manifestations can be varied and nonspecific. A wide spectrum of neoplastic and nonneoplastic renal pathologies may result in WS. Renal neoplasms are the most common cause for WS, with angiomyolipoma being the most common benign neoplasm, whereas renal cell carcinoma is the most common malignant neoplasm. Other causative conditions of WS include vascular causes (vasculitis [polyarteritis nodosa being the most common cause], renal artery aneurysms, arteriovenous malformations and fistulas, and venous thrombosis), cystic renal diseases, renal infections, calculus disease, nephritis, and coagulation disorders. Cross-sectional imaging findings help in the detection of the subcapsular and/or perinephric hemorrhage and may identify underlying etiology. Renal angiography not only helps in diagnosis of the underlying cause in select cases but also allows control of active bleeding, which can avoid unnecessary emergent radical surgery.

From the *Department of Radiology, University of Texas Health Science Center at San Antonio; †Department of Radiology, University of Texas MD Anderson Cancer Center; and ‡Department of Radiology, University of Texas Health Science Center at Houston, Houston, TX.

Received for publication February 22, 2011; accepted April 15, 2011.

Reprints: Venkata S. Katabathina, MD, Radiology Department, University of Texas HSC at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.