Volume 28, Issue 149, July 2024

Wunderlich Syndrome - misdiagnosed mystery: Introduction and case report

Kinga Piela^1♦, Cezary Bochyński², Jolanta Mazurek³, Anna Józefiak⁴, Magdalena Szczepanik⁵, Gabriela Mazurek⁶, Maciej Horbaczewski⁷, Przemysław Hałasiński⁸, Dominika Kropidłowska⁹, Maria Myślicka¹⁰, Patryk Góralski¹¹, Klaudia Włodarczyk¹⁰

¹Hospital Emergency Department, University Clinical Hospital Fryderyk Chopin in Rzeszów, Fryderyka Szopena 2, 35-055 Rzeszów, Poland
²Department of Internal Medicine, Railway Hospital Włodzimierz Roefler, MD, PhD in Pruszków, Warsztatowa 1, 05-800 Pruszków, Poland
³Primary Health Care, Private health care facility "ALMUS" Jacek Pieniazek, Białoboki 137, 37-207 Gać, Poland ⁴Department of Internal Diseases and Endocrinology, Gabriel Narutowicz Municipal Specialist Hospital in Cracow, Prądnicka 35-37, 31-202 Cracow, Poland
⁵Department of Pediatrics, District Hospital in Chrzanów, Topolowa 16, 32-500 Chrzanów, Poland
⁶Department of Cardiology and Internal Diseases, Gabriel Narutowicz Municipal Specialist Hospital in Cracow, Prądnicka 35-37, 31-202 Cracow, Poland
⁷Hospital Emergency Department, District Health Center Kartuzy, Floriana Ceynowy 7, 83-300 Kartuzy, Poland
⁸Clinical Department of Gastroenterology, Metabolic, Internal Diseases and Dietetics, University Clinical Hospital in Poznań, 49 Przybyszewskiego, 60-355 Poznań, Poland
⁹Polish Red Cross Maritime Hospital in Gdynia, Powstania Styczniowego 1, 81-519 Gdynia, Poland
¹⁰Wroclaw Medical University, wyb. Ludwika Pasteura 1, 50-367 Wroclaw, Poland
¹¹University Clinical Center in Gdańsk, Dębinki 7, 80-952 Gdańsk, Poland

^♦Corresponding Author
Hospital Emergency Department, University Clinical Hospital Fryderyk Chopin in Rzeszów, Fryderyka Szopena 2, 35-055 Rzeszów, Poland

ABSTRACT

Introduction: Wunderlich syndrome is a spontaneous, nontraumatic, and rare subcapsular perinephric hematoma. Since 2013, only about 280 cases have been reported. The main symptoms suggestive of this syndrome are flank or lumbar pain, flank mass, hypovolemic shock. Some patients also experience massive hematuria. Yet, not only the acute symptoms indicate the risks associated with this syndrome. Methodology: This case report was conducted by searching for current papers on PubMed and Google Scholar using the search phrases (Wunderlich Syndrome) AND (Angiomyolipoma) AND (Nephrectomy). After eliminating duplicates, we appraised all publications using the titles and abstracts. Following an exact revision of complete manuscripts, 25 articles met the inclusion criteria. The research took place in April 2024. The Aim: This work shows how serious complications can occur in people with Wunderlich syndrome and the diagnostic problems. Case Report: This work presents a 70- year-old patient with low blood pressure and severe abdominal pain. Results: WS is characterized by flank or lumbar pain, flank mass, hypovolemic shock. The diagnosis is based on CT scans and intra-surgical evaluation. Conclusions: WS is a rare disease, causes symptoms of severe abdominal pain and internal bleeding. The key to correct diagnosis of the syndrome is imaging tests and surgical intervention. In this case, computed tomography scan and emergency nephrectomy were used to save the patient.

Keywords: Kidney, tumor, urology, wunderlich, emergency medicine, angiomyolipoma, AML.

Medical Science, 2024, 28, e85ms3387

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DOI: https://doi.org/10.54905/disssi.v28i149.e85ms3387

Published: 29 July 2024