Wunderlich syndrome

Wunderlich syndrome is a very rare syndrome named after the German physician Carl Wunderlich. The syndrome is manifested by spontaneous subcapsular/perirenal hemorrhage of non-traumatic origin. The whole syndrome is characterized by the so-called Lenka triad:
 * flank pain;
 * palpable resistance in the flank;
 * hypovolemia (even hypovolemic shock).

Etiology
From the etiological point of view, the syndrome can be divided into neoplastic and non-neoplastic causes. The most common of neoplastic benign causes is renal angiomyolipoma, of neoplastic malignancies renal cell carcinoma. Non-neoplastic causes include aneurysm of the renal artery, polyarteritis nodosa, venous thrombosis, the presence of fistulas, cysts, ...

Treatment
Conservative (which means rehydration, transfusion, etc.) in case of hemodynamic stability of the patient. In case of destabilization or failure, nephrectomy is required, or angiographic selective embolization.