Wunderlich syndrome: Diagnosis and management of a clinical case

Wunderlich syndrome is a rare condition characterized by acute and spontaneous renal hemorrhage in the subcapsular, perirenal, or pararenal spaces, without prior trauma. Symptoms can vary from flank pain to hypovolemic shock. The classic Lenk triad (pain, flank mass, and hypovolemic shock) is observed in approximately 20% of patients. Renal neoplasms, such as angiomyolipomas and renal carcinomas, account for 60 to 65% of cases. Renal vascular diseases (aneurysms, arteriovenous malformations, and vasculitis) represent 20 to 30% of cases. Rare causes include renal infections, cystic diseases, renal stones, renal failure, and coagulation disorders, though Wunderlich syndrome can also be idiopathic. CT (computed tomography) scans and MRIs are essential for detecting and characterizing underlying causes, with follow-up studies sometimes necessary when no clear cause is found. Renal artery embolization may be used as a minimally invasive treatment for acute hemorrhage. Timely diagnosis is crucial to prevent hemodynamic instability, particularly in patients with rare causes such as infections. This article presents the case of a 17-year-old male initially diagnosed with a renal abscess, which progressed into Wunderlich syndrome due to bilateral pyelonephritis.