Wünderlich syndrome: the importance of an early diagnosis

A 73-year-old female hypertensive patient treated with edoxaban consulted for acute pain in the right flank with no prior trauma, at which time she was stable, tachycardic, with a normal abdomen except for positive percussion of the right kidney. Lab workup showed 21,200 leukocytes and PT 45. Ultrasound demonstrated a large renal subcapsular hematoma. CT scan (Fig. 1) revealed acute hematoma, extensive subcapsular involvement (20 × 3.2 cm) and extravasation of contrast, suggestive of Wünderlich syndrome. The patient was successfully treated with selective embolization, and follow-up CT scan confirmed complete resolution 3 months later. This syndrome is a rare but potentially fatal entity that requires early diagnosis and management. It is also associated with neoplastic etiology in >60%.

Fig. 1