Wünderlich's syndrome: causes, diagnosis and radiological management

The underlying causes of the Wünderlich syndrome, spontaneous renal bleeding confined to the subcapsular and perirenal space, are described together with its radiologic management.

A total of 9 cases, occurring in our hospital between 1995 and 2001 were reviewed. The average age was 46 and five of them were women. All patients underwent ultrasound and helical CT. In seven cases renal arteriography was performed, in 6 the bleeding artery was embolized. Histological material was obtained in four cases.

The most common cause was of neoplastic origin (five angiomyolipomas and one urothelial carcinoma of the renal pelvis). Other unusual cases included a pancreatic pseudocyst with rupture of the renal parenchyma and a drug induced vasculitis. In one patient a definitive diagnosis was not obtained. In five of the 6 cases in which the bleeding artery was embolized, the results were satisfactory and only one patient required surgery because of persistent bleeding.

CT is the best imaging method to establish the diagnosis and in some cases the aetiology of Wünderlich's syndrome. Renal arteriography with embolization is an important therapeutic method to control the bleeding and to avoid surgery.