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Chia JCH, Chong CJ, Yong YR, Tan PY. Wunderlich syndrome in a patient with pyelonephritis. BMJ Case Rep 2024; 17:e257325. [PMID: 38442961 PMCID: PMC10916142 DOI: 10.1136/bcr-2023-257325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
An elderly female patient with left pyelonephritis developed worsening left flank pain, hypotension and a drop in haemoglobin (Hb) from 97 g/L to 67g/L on the third day of her admission. There was no recent trauma, history of coagulopathy or risk factors for renal malignancy or vascular disease.A contrasted CT scan of the kidneys revealed a 3.8 cm left renal subcapsular haematoma with no active contrast extravasation. Her atraumatic subcapsular haematoma fulfils two out of three clinical features of Lenk's triad (acute flank pain, hypovolaemic shock), suggestive of Wunderlich syndrome. Urine and blood cultures grew Klebsiella pneumoniae and she was managed conservatively with culture-directed antibiotics, fluids and blood products.Wunderlich syndrome is a rare complication of pyelonephritis and should be considered in patients with pyelonephritis who develop acute severe flank pain, Hb drop and haemodynamic instability. Appropriate medical and surgical therapies need to be instituted early to ensure good outcomes.
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Affiliation(s)
| | | | - Yan Rong Yong
- Department of Radiology, Changi General Hospital, Singapore
| | - Poh Yong Tan
- Department of Internal Medicine, Singapore General Hospital, Singapore
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Does spontaneous renal hemorrhage mandate close surveillance for impending renal cell carcinoma? A case report and literature review. Int J Surg Case Rep 2020; 73:44-47. [PMID: 32634616 PMCID: PMC7339000 DOI: 10.1016/j.ijscr.2020.06.067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/09/2020] [Accepted: 06/13/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Renal cell carcinoma (RCC) classically presents as a triad of hematuria, loin pain, and a palpable mass. However, Renal cell carcinomas (RCCs) nowadays are more commonly present as incidental findings rather than symptomatic. Wunderlich syndrome is a rare first presentation of RCC. PRESENTATION OF CASE We present a clinical case of spontaneous renal hemorrhage with unclear etiology that was treated with therapeutic embolization and was found to have renal mass after long follow up. DISCUSSION AND CONCLUSION In regards to treating Wunderlich syndrome, some authors favor angioembolization and follow up. Others proposed radical nephrectomy in conditions with no apparent etiology and normal contralateral kidney because of the high incidence of small renal tumors. Spontaneous perinephric hematoma of unknown etiology should be followed up regularly with a CT image for concerning of impending renal tumor.
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Hamidi O, Raman R, Lazik N, Iniguez-Ariza N, McKenzie TJ, Lyden ML, Thompson GB, Dy BM, Young WF, Bancos I. Clinical course of adrenal myelolipoma: A long-term longitudinal follow-up study. Clin Endocrinol (Oxf) 2020; 93:11-18. [PMID: 32275787 PMCID: PMC7292791 DOI: 10.1111/cen.14188] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 03/23/2020] [Accepted: 03/30/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE We aimed to describe clinical course of myelolipoma and to identify predictors of tumour growth and need for surgery. DESIGN A retrospective study. PATIENTS Consecutive patients with myelolipoma. RESULTS A total of 321 myelolipomas (median size, 2.3 cm) were diagnosed in 305 patients at median age of 63 years (range, 25-87). Median follow-up was 54 months. Most myelolipomas were incidentally detected (86%), whereas 9% were discovered during cancer staging and 5% during workup of mass effect symptoms. Thirty-seven (12%) patients underwent adrenalectomy. Compared to myelolipomas <6 cm, tumours ≥6 cm were more likely to be bilateral (21% vs 3%, P < .0001), cause mass effect symptoms (32% vs 0%, P < .0001), have haemorrhagic changes (14% vs 1%, P < .0001) and undergo adrenalectomy (52% vs 5%, P < .0001). Among patients with ≥6 months of imaging follow-up, median size change was 0 mm (-10, 115) and median growth rate was 0 mm/y (-6, 14). Compared to <1 cm growth, ≥1 cm growth correlated with larger initial size (3.6 vs 2.3 cm, P = .02), haemorrhagic changes (12% vs 2%, P = .007) and adrenalectomy (35% vs 8%, P < .0001). CONCLUSIONS Most myelolipomas are incidentally discovered on cross-sectional imaging. Myelolipomas ≥6 are more likely to cause mass effect symptoms, have haemorrhagic changes and undergo resection. Tumour growth ≥1 cm is associated with larger myelolipoma and haemorrhagic changes. Adrenalectomy should be considered in symptomatic patients with large tumours and when there is evidence of haemorrhage or tumour growth.
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Affiliation(s)
- Oksana Hamidi
- Division of Endocrinology and Metabolism, UT Southwestern Medical Center, Dallas, TX, USA
- Division of Endocrinology, Diabetes, and Nutrition, Mayo Clinic, Rochester, MN, US
| | - Ram Raman
- Department of Medicine, Charles University, Prague, Czech Republic
| | - Natalia Lazik
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Nicole Iniguez-Ariza
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | | | - Benzon M. Dy
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - William F. Young
- Division of Endocrinology, Diabetes, and Nutrition, Mayo Clinic, Rochester, MN, US
| | - Irina Bancos
- Division of Endocrinology, Diabetes, and Nutrition, Mayo Clinic, Rochester, MN, US
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Abstract
INTRODUCTION Adrenal myelolipoma is an invariably benign neoplasm of the adrenal gland that is the second most common primary adrenal incidentaloma following adrenocortical adenomas. It is composed of elements of adipose tissue and extramedullary hematopoiesis. Hypotheses on stem cells and hormonal factors have been formulated regarding its pathogenesis that is still obscure. Despite its benign behavior, adrenal myelolipoma is clinically relevant as it might cause significant difficulties in the differential diagnosis of adrenal tumors. METHODS We have reviewed 420 cases reported between 1957 and 2017 on adrenal myelolipoma retrieved from PubMed and Scopus databases and also 20 of our case series to provide a comprehensive analysis of their pathology, epidemiological and clinical features. RESULTS AND CONCLUSIONS The average age for its diagnosis was 51 years, and no gender difference was observed. The average size of tumors was 10.2 cm. Congenital adrenal hyperplasia was associated to 10% of all cases analyzed, while other adrenal hypersecretory disorders (cortisol, aldosterone) were found in 7.5% of cases. Computed tomography and magnetic resonance imaging can be reliably used for its differential diagnosis. If the diagnosis of an adrenal myelolipoma is unambiguous, and no associated symptoms or hormonal activity are established, surgical intervention is usually not necessary.
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Affiliation(s)
- Ábel Decmann
- 2nd Department of Medicine, Semmelweis University, Szentkirályi str. 46., Budapest, 1088, Hungary
| | - Pál Perge
- 2nd Department of Medicine, Semmelweis University, Szentkirályi str. 46., Budapest, 1088, Hungary
| | - Miklós Tóth
- 2nd Department of Medicine, Semmelweis University, Szentkirályi str. 46., Budapest, 1088, Hungary
| | - Peter Igaz
- 2nd Department of Medicine, Semmelweis University, Szentkirályi str. 46., Budapest, 1088, Hungary.
- MTA-SE Molecular Medicine Research Group, Hungarian Academy of Sciences and Semmelweis University, Szentkirályi str. 46., Budapest, 1088, Hungary.
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Chromophobe Renal Cell Carcinoma Presented with Wunderlich Syndrome. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2017. [DOI: 10.5812/ijcm.8057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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6
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Sudden onset flank pain: Spontaneous renal rupture. Am J Emerg Med 2017; 35:1787.e1-1787.e3. [DOI: 10.1016/j.ajem.2017.07.095] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 07/30/2017] [Indexed: 11/22/2022] Open
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Mao Y, De Oliveira I, Hedgire S, Prapruttam D, Harisinghani M. Aetiology, imaging features, and evolution of spontaneous perirenal haemorrhage. Clin Radiol 2017; 72:175.e19-175.e26. [DOI: 10.1016/j.crad.2016.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/18/2016] [Accepted: 08/31/2016] [Indexed: 02/01/2023]
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Pigolkin YI, Dolzhansky OV, Pal'tseva EM, Shilova MA, Fedorov DN, Boeva SE. [The forensic medical evaluation of traumatic and spontaneous ruptures of the organs affected by the tumours]. Sud Med Ekspert 2017; 60:49-56. [PMID: 28399088 DOI: 10.17116/sudmed201760249-56] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The present article was designed to report the results of the analysis of the cases of traumatic and spontaneous ruptures of the organs affected by the tumours based on the original observations and the literature data. It is shown that the probability of the tumour rupture depends on its histological type, localization, the size, and the distance from the capsule of the affected organ, the degree of involvement of the major blood vessels, the severity of the necrotic changes, the presence of cysts in the neoplasm, and the regimens of radio- and chemotherapy. Moreover, the rupture can be facilitated by anticoagulation therapy, intake or oral contraceptives, pregnancy, concomitant diseases, alcoholic intoxication, splenomegaly, and hypocoagulation resulting from dissemination of the neoplastic process or the metastatic lesions of the liver. Even a minimal injury to the skin can provoke the tumour rupture associated with the fatal hemorrhage. A delayed rupture within a few hours or days is possible.
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Affiliation(s)
- Yu I Pigolkin
- Department of Forensic Medicine, I.M. Sechenov First Moscow State Medical University, Russian Ministry of Health, Moscow, Russia, 119991
| | - O V Dolzhansky
- B.V. Petrovsky Russian Research Centre of Surgery, Russian Ministry of Health, Moscow, Russia, 119991
| | - E M Pal'tseva
- B.V. Petrovsky Russian Research Centre of Surgery, Russian Ministry of Health, Moscow, Russia, 119991
| | - M A Shilova
- Department of Forensic Medicine, I.M. Sechenov First Moscow State Medical University, Russian Ministry of Health, Moscow, Russia, 119991
| | - D N Fedorov
- B.V. Petrovsky Russian Research Centre of Surgery, Russian Ministry of Health, Moscow, Russia, 119991
| | - S E Boeva
- Department of Forensic Medicine, I.M. Sechenov First Moscow State Medical University, Russian Ministry of Health, Moscow, Russia, 119991
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Zhu G, Wu D, Wu K, Song W, Yang Z, Zhang Y, Zhang L, He D. The Retroperitoneal Laparoscopic Renal Capsulectomy for Spontaneous Renal Subcapsular Fluid Collection: A Case-Series Report and Literature Review. Medicine (Baltimore) 2016; 95:e3751. [PMID: 27227941 PMCID: PMC4902365 DOI: 10.1097/md.0000000000003751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Spontaneous renal subcapsular fluid collection may occur as a rare presentation of nephritic syndrome, and distension of the renal capsula and Gerota fascia due to massive fluid accumulation may cause pain. In addition, hypertension secondary to renal ischemia and activation of renin-angiotensin-aldosterone system may also occur. The objective of this study is to evaluate the surgical outcome of retroperitoneal laparoscopic renal capsulectomy for patients with this disease.We retrospectively analyzed the clinical data of 10 female patients with spontaneous renal subcapsular fluid collection, diagnosed with B ultrasound and enhanced computed tomography (CT) scan. Eight patients first underwent percutaneous renal subcapsular drainage, which seemed to be less effective, and then all patients underwent retroperitoneal laparoscopic renal capsulectomy. The volume of renal subcapsular fluid was documented, the fluid was examined by routine biochemical tests, and the excised renal capsules underwent pathological examination individually. The postoperative drainage time for each patient was documented, and follow-up was conducted 1, 3, 6, 12 months, and 2 years postoperatively.Retroperitoneal laparoscopic renal capsulectomy was successfully performed in all patients with no major complications. The average volume of renal subcapsular fluid was 436 milliliter (mL, 180-880 mL) in light yellow color, and the concentration of creatinine and urea nitrogen was quite similar to that of serum. The pathological findings revealed fibrous dysplasia of the renal capsule with chronic infiltration of inflammatory cells. The average drainage time was 11.5 days (5-30 days) postoperatively. All patients recovered 1 month after the operation and there were no recurrences with a mean follow-up period of 12 months (6-24 months).The reason for spontaneous renal subcapsular fluid collection is unknown, and the aim of treatment is mainly to alleviate symptoms. In our experience, retroperitoneal laparoscopic renal capsulectomy is an effective surgical treatment, especially for patients who were refractory to percutaneous renal subcapsular drainage, with no observed recurrence.
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Affiliation(s)
- Guodong Zhu
- From the Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P. R. of China
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Letter to the editor: spontaneous renal haemorrhage in end-stage renal disease. Insights Imaging 2015; 6:693-5. [PMID: 26472545 PMCID: PMC4656237 DOI: 10.1007/s13244-015-0439-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 09/28/2015] [Indexed: 11/12/2022] Open
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Hammond NA, Lostumbo A, Adam SZ, Remer EM, Nikolaidis P, Yaghmai V, Berggruen SM, Miller FH. Imaging of adrenal and renal hemorrhage. ACTA ACUST UNITED AC 2015; 40:2747-60. [DOI: 10.1007/s00261-015-0453-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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12
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Nanjappa B, Chiruvella M, Reddy PC, Ragoori D, Bendigeri MT. Spontaneous rupture of renal cell carcinoma: A series of three cases. South Asian J Cancer 2015; 4:48-9. [PMID: 25839026 PMCID: PMC4382790 DOI: 10.4103/2278-330x.149956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Bhuvanesh Nanjappa
- Department of Urology, Asian Institute of Nephrology and Urology, Hyderabad, Andhra Pradesh, India
| | - Mallikarjuna Chiruvella
- Department of Urology, Asian Institute of Nephrology and Urology, Hyderabad, Andhra Pradesh, India
| | - Purna Chandra Reddy
- Department of Urology, Asian Institute of Nephrology and Urology, Hyderabad, Andhra Pradesh, India
| | - Deepak Ragoori
- Department of Urology, Asian Institute of Nephrology and Urology, Hyderabad, Andhra Pradesh, India
| | - Mohammed Taif Bendigeri
- Department of Urology, Asian Institute of Nephrology and Urology, Hyderabad, Andhra Pradesh, India
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Tonolini M, Rigiroli F, Villa F, Bianco R. Complications of sporadic, hereditary, and acquired renal cysts: cross-sectional imaging findings. Curr Probl Diagn Radiol 2014; 43:80-90. [PMID: 24629661 DOI: 10.1067/j.cpradiol.2013.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Commonly encountered in the general adult and elderly population, in most cases simple renal cysts are confidently diagnosed on imaging studies and do not require further workup or treatment. However, large or growing renal cysts sometimes cause symptoms or signs such as hypertension, palpable mass, flank or abdominal pain, obstructive uropathy, and hematuria, which may indicate the need for minimally invasive percutaneous or laparoscopic treatment. Furthermore, severe complications such as cystic hemorrhage, rupture, or superinfection may occur, particularly in patients with polycystic renal disorders, either hereditary (namely adult polycystic kidney diseases) or acquired in chronic renal failure. This pictorial essay reviews and discusses the cross-sectional imaging appearances of symptomatic and complicated sporadic, hereditary, and acquired renal cysts. Early cross-sectional imaging with multidetector computed tomography or magnetic resonance imaging or both, including contrast enhancement unless contraindicated by renal dysfunction, is warranted to investigate clinical and laboratory signs suggesting retroperitoneal hemorrhage or infection in patients with pre-existent renal cysts, particularly if large, multiple, or hereditary.
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Affiliation(s)
- Massimo Tonolini
- Department of Radiology, "Luigi Sacco" University Hospital, Milan, Italy.
| | - Francesca Rigiroli
- Department of Radiology, "Luigi Sacco" University Hospital, Milan, Italy
| | - Federica Villa
- Department of Radiology, "Luigi Sacco" University Hospital, Milan, Italy
| | - Roberto Bianco
- Department of Radiology, "Luigi Sacco" University Hospital, Milan, Italy
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Laparoscopic excision of a renal subcapsular abscess presenting as a subcapsular haematoma. W INDIAN MED J 2013; 63:98-100. [PMID: 25303183 DOI: 10.7727/wimj.2012.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 08/29/2012] [Indexed: 11/18/2022]
Abstract
Renal subcapsular abscess is a very rare entity that is defined by a suppurative process localized to a space between the renal capsule and the renal parenchyma. The pathogenesis and aetiology of this entity remain speculative. To our knowledge, only five cases have been reported in the English literature. We describe a 74-year old woman with renal subcapsular abscess treated with laparoscopic removal and do a review of the literature.
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Man With Sudden Onset of Bilateral Flank Pain. Ann Emerg Med 2012; 60:e7-8. [DOI: 10.1016/j.annemergmed.2012.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Revised: 03/29/2012] [Accepted: 03/29/2012] [Indexed: 11/16/2022]
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16
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Mitsogiannis IC, Chatzidarellis E, Skolarikos A, Papatsoris A, Anagnostopoulou G, Karagiotis E. Bilateral spontaneous retroperitoneal bleeding in a patient on nimesulide: a case report. J Med Case Rep 2011; 5:568. [PMID: 22152335 PMCID: PMC3251624 DOI: 10.1186/1752-1947-5-568] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 12/09/2011] [Indexed: 12/20/2022] Open
Abstract
Introduction Spontaneous retroperitoneal bleeding is a rare but potentially life-threatening event of varied etiology. Herein we report a case of bilateral non-traumatic retroperitoneal hemorrhage. Case presentation A 50-year-old Greek man, who was on a non-steroidal anti-inflammatory agent (nimesulide) for ankylosing spondylitis, presented with a right retroperitoneal hematoma combined with contralateral subcapsular renal hematoma. Bleeding on his right side was successfully controlled by arterial embolization with coils, whereas the left renal hematoma was treated conservatively. His recovery period was uneventful. Conclusion This is the first reported case of bilateral retroperitoneal bleeding in a patient receiving nimesulide for ankylosing spondylitis. The application of minimally invasive techniques resulted in the desired positive outcome with preservation of both renal units.
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Abstract
Wunderlich syndrome (WS) is a rare condition characterized by acute onset of spontaneous, nontraumatic renal hemorrhage into the subcapsular and perirenal spaces. Wunderlich syndrome is classically characterized by the Lenk's triad: acute flank pain, flank mass, and hypovolemic shock. However, the clinical manifestations can be varied and nonspecific. A wide spectrum of neoplastic and nonneoplastic renal pathologies may result in WS. Renal neoplasms are the most common cause for WS, with angiomyolipoma being the most common benign neoplasm, whereas renal cell carcinoma is the most common malignant neoplasm. Other causative conditions of WS include vascular causes (vasculitis [polyarteritis nodosa being the most common cause], renal artery aneurysms, arteriovenous malformations and fistulas, and venous thrombosis), cystic renal diseases, renal infections, calculus disease, nephritis, and coagulation disorders. Cross-sectional imaging findings help in the detection of the subcapsular and/or perinephric hemorrhage and may identify underlying etiology. Renal angiography not only helps in diagnosis of the underlying cause in select cases but also allows control of active bleeding, which can avoid unnecessary emergent radical surgery.
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Wünderlich syndrome: an unusual cause of flank pain. Am J Emerg Med 2011; 29:474.e1-3. [DOI: 10.1016/j.ajem.2010.04.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Accepted: 04/22/2010] [Indexed: 11/19/2022] Open
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Diaz JR, Agriantonis DJ, Aguila J, Calleros JE, Ayyappan AP. Spontaneous perirenal hemorrhage: what radiologists need to know. Emerg Radiol 2011; 18:329-34. [PMID: 21344245 DOI: 10.1007/s10140-011-0944-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Accepted: 02/03/2011] [Indexed: 10/18/2022]
Abstract
Spontaneous perirenal hemorrhage (SPH), also known as Wünderlich's syndrome, is a rare urological emergency. This article reviews the most common causes of SPH and the role of imaging in establishing the correct diagnosis and in guiding the appropriate therapy. A thorough understanding of underlying etiologies, imaging appearances, optimal imaging techniques, and follow-up protocols are crucial to recognize patients with SPH due to benign disease and avoid unnecessary nephrectomies.
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Affiliation(s)
- Jesus R Diaz
- Department of Radiology, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, 4800 Alberta Avenue, El Paso, TX 79905, USA.
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Affiliation(s)
- Yan-Ying Lin
- Emergency Department, Taipei Veterans General Hospital, Taiwan
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Akpinar E, Turkbey B, Eldem G, Karcaaltincaba M, Akhan O. When do we need contrast-enhanced CT in patients with vague urinary system findings on unenhanced CT? Emerg Radiol 2008; 16:97-103. [PMID: 18665401 DOI: 10.1007/s10140-008-0752-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Accepted: 07/08/2008] [Indexed: 11/25/2022]
Abstract
Determination of renal neoplasms, hematoma, infarct, urinoma, cysts, and pyelonephritis may require contrast material administration following unenhanced CT in patients with flank pain. In this pictorial review, we aimed to clarify when contrast material administration is needed following vague urinary system findings on unenhanced CT.
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Affiliation(s)
- Erhan Akpinar
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
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Oncologic Emergencies. EMERGENCIES IN UROLOGY 2007. [PMCID: PMC7120542 DOI: 10.1007/978-3-540-48605-3_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
It has been estimated that genitourinary malignancies will account for 25% of new cancer diagnoses in the United States in 2005 (Jemal et al. 2005). While the incidence of many of these malignancies has increased over the past two decades, the mortality rates appear to be decreasing. Early cancer detection combined with improvements in surgical and nonsurgical oncologic therapy account for these trends. Although not common, newly diagnosed cancer patients occasionally present in an emergent, life-threatening manner that warrants immediate medical or surgical intervention. As the prevalence of genitourinary malignancies continues to expand, additional patients can be expected to develop disease or treatment-related complications. This chapter will serve to review the diagnosis and management of oncologic emergencies as they pertain to the urologist.
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Rucker CM, Menias CO, Bhalla S. Mimics of Renal Colic: Alternative Diagnoses at Unenhanced Helical CT. Radiographics 2004; 24 Suppl 1:S11-28; discussion S28-33. [PMID: 15486235 DOI: 10.1148/rg.24si045505] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
During the past decade, unenhanced computed tomography (CT) has become the standard of reference in the detection of urinary calculi owing to its high sensitivity (>95%) and specificity (>98%) in this setting. Numerous diseases may manifest as acute flank pain and mimic urolithiasis. Up to one-third of unenhanced CT examinations performed because of flank pain may reveal unsuspected findings unrelated to stone disease, many of which can help explain the patient's condition. Alternative diagnoses are most commonly related to gynecologic conditions (especially adnexal masses) and nonstone genitourinary disease (eg, pyelonephritis, renal neoplasm), closely followed by gastrointestinal disease (especially appendicitis and diverticulitis). Hepatobiliary, vascular, and musculoskeletal conditions may also be encountered. Vascular causes of acute flank pain must always be considered, since these constitute life-threatening emergencies that may require the intravenous administration of contrast material for diagnosis. Radiologists must be familiar with the typical findings of urinary stone disease at unenhanced CT, as well as the spectrum of alternative diagnoses that may be detected with this modality, to accurately diagnose the source of flank pain.
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Affiliation(s)
- Creed M Rucker
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110, USA
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Chow K, Mahadanaarachchi J, Baird A, Rowlands P, Cornford PA. Massive peri-renal haemorrhage from ruptured renal artery aneurysm in the presence of normal renal function. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 2003; 36:389-90. [PMID: 12487748 DOI: 10.1080/003655902320783944] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A 65-year-old man presented acutely with a large right peri-nephric haematoma as seen on a CT scan. Intravenous urography demonstrated normal function. An arteriogram later revealed a 1 cm renal artery tributary aneurysm, which was successfully embolized.
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Affiliation(s)
- K Chow
- Department of Urology, Royal Liverpool University Hospital, Liverpool, UK.
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26
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Albi G, del Campo L, Tagarro D. Wünderlich's Syndrome: Causes, Diagnosis and Radiological Management. Clin Radiol 2002. [DOI: 10.1053/crad.2002.0981] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
PURPOSE We determine the most common etiology of spontaneous perirenal hemorrhage. MATERIALS AND METHODS A MEDLINE search of the English language literature from 1985 to 1999 revealed 47 publications and 165 cases of spontaneous renal hemorrhage meeting our study entry criteria. These criteria were presentation of raw data including imaging modality, pathological confirmation (123 cases) or long-term (greater than 2 years) (42) imaging and/or clinical followup and no history of recent trauma, anticoagulant use, dialysis or renal transplant. Meta-analysis was performed using analysis of counts derived from contingency tables and pooled and stratified analysis. RESULTS Hemorrhage was identified by ultrasound in 56 of 100 cases (56%) and by computerized tomography (CT) in all 135 cases assessed (100%). Etiology was correctly identified with an overall sensitivity and specificity of 0.11 and 0.33 for ultrasound and 0.57 and 0.82 for CT. Angiography in 81 cases revealed active bleeding in 11. The most common etiology of spontaneous renal hemorrhage was benign or malignant neoplasm (101 cases, 61%) with angiomyolipoma being predominant (48) followed closely by renal cell carcinoma (43). Vascular disease was the next most common offender (28 cases, 17%) with polyarteritis nodosa occurring most frequently (20). CONCLUSIONS The most common cause of spontaneous perirenal hemorrhage is renal neoplasm and approximately 50% of such neoplasms are malignant. CT is the method of choice for evaluation of perirenal hemorrhage, although its sensitivity for detection of underlying etiology is only moderate.
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Affiliation(s)
- Jian Qing Zhang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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28
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Abstract
PURPOSE We determine the most common etiology of spontaneous perirenal hemorrhage. MATERIALS AND METHODS A MEDLINE search of the English language literature from 1985 to 1999 revealed 47 publications and 165 cases of spontaneous renal hemorrhage meeting our study entry criteria. These criteria were presentation of raw data including imaging modality, pathological confirmation (123 cases) or long-term (greater than 2 years) (42) imaging and/or clinical followup and no history of recent trauma, anticoagulant use, dialysis or renal transplant. Meta-analysis was performed using analysis of counts derived from contingency tables and pooled and stratified analysis. RESULTS Hemorrhage was identified by ultrasound in 56 of 100 cases (56%) and by computerized tomography (CT) in all 135 cases assessed (100%). Etiology was correctly identified with an overall sensitivity and specificity of 0.11 and 0.33 for ultrasound and 0.57 and 0.82 for CT. Angiography in 81 cases revealed active bleeding in 11. The most common etiology of spontaneous renal hemorrhage was benign or malignant neoplasm (101 cases, 61%) with angiomyolipoma being predominant (48) followed closely by renal cell carcinoma (43). Vascular disease was the next most common offender (28 cases, 17%) with polyarteritis nodosa occurring most frequently (20). CONCLUSIONS The most common cause of spontaneous perirenal hemorrhage is renal neoplasm and approximately 50% of such neoplasms are malignant. CT is the method of choice for evaluation of perirenal hemorrhage, although its sensitivity for detection of underlying etiology is only moderate.
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Affiliation(s)
- Jian Qing Zhang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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29
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Abstract
This is a case of a 51-year-old female with difficult-to-control hypertension and a 3-cm renal artery aneurysm. Successful exclusion of this was performed using a prefabricated stent graft. To our knowledge, this is the first report on the use of a prefabricated covered stent for this indication.
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Affiliation(s)
- W A Tan
- Department of Interventional Radiology and Cardiology, Pittsburgh Vascular Institute, University of Pittsburgh Medical Center, Shadyside, Pittsburgh, PA 15232, USA
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30
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Abstract
CT performed without oral or intravenous contrast is the initial imaging study of choice in many situations for the detection of hemorrhage anywhere in the abdomen and pelvis. The presence or absence of hemorrhage can be determined rapidly, and the amount and precise location of hemorrhage can also be evaluated. This article reviews the appearances and the common and unusual etiologies of abdominal and pelvic hemorrhage on unenhanced CT. The role of intravenous contrast-enhanced CT in patients with known or suspected abdominal and pelvic hemorrhage is also examined.
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Affiliation(s)
- D S Katz
- Department of Radiology, Winthrop-University Hospital, Mineola, NY 11501, USA
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