Spontaneous subcapsular hematoma in chronic kidney disease

Spontaneous hemorrhage in the kidney, also known as Wunderlich Syndrome is a rare clinical problem and it's occurrence raises clinical suspicion of the presence of an underlying malignancy. Herein we present two cases that presented with severe spontaneous subcapsular hemorrhage, where no underlying structural abnormality was identified, despite a careful search. The common feature in these two cases was the presence of an underlying chronic kidney disease, a known cause of coagulopathy, but a previously unrecognized association with Wunderlich syndrome. The literature on spontaneous kidney hemorrhage in the modern imaging era is also reviewed.