In-flight Valsalva maneuver induced life-threatening Wünderlich syndrome

Valsalva maneuver, a preferred method for induction of a complex cardiovascular response, is often performed to relieve ear block during descent in aviation. We described a rare case of Wünderlich syndrome presenting with characteristic clinical and imaging features of ruptured renal angiomyolipoma (AML) induced by a Valsalva maneuver. Renal AML heralded by unbridled hemorrhage is a disastrous entity that can be easily overlooked. Early recognition by exquisite imaging studies along with a raised clinical awareness can forestall unnecessary surgical exploration, preserve renal function, and avoid a life-threatening catastrophe.