Wunderlich syndrome in a hypertensive male with multiple renal arteries: a rare case report

Wunderlich syndrome (WS) is a rare clinical condition characterized by spontaneous, non-traumatic renal hemorrhage. Although neoplasms and vascular lesions are common causes, its association with multiple renal arteries (MRA) is rarely described.

A 51-year-old hypertensive male presented with left flank pain, fullness, and flank ecchymosis without preceding trauma. Contrast-enhanced computed tomography (CT) revealed a large left perirenal hematoma (~790 ml) consistent with AAST Grade III renal injury, without evidence of tumor or aneurysm. CT angiography demonstrated three left renal arteries without active extravasation. The patient was managed conservatively with close monitoring and supportive care, resulting in complete recovery.

Although MRA is a frequent anatomical variant, it may predispose individuals to focal vascular weakness or microaneurysm formation, particularly in hypertensive individuals, thereby contributing to spontaneous renal hemorrhage.

WS should be considered in patients presenting with spontaneous flank pain and ecchymosis. Contrast-enhanced CT with angiography remains the diagnostic gold standard. The treatment modalities vary depending on the hemodynamic status of the patient, ranging from conservative management to operative intervention.