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Case of the Month

November 2007

Patient Data: 51 year old female

Clinical Info: Sudden pain in the right flank


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Longitudinal image of the right kidney with an inhomogeneous mass in the lowerpole of the kidney with a hyperechoic rim and a perirenal effusion


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Longitudinal image of the kidney with a hyperechoic rim and a perirenal effusion


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Transverse image of the kidney with a hyperechoic rim and a perirenal effusion


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Detail of the mass lesion with very high echogenicity


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The lesion is poorly vascularized


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CT scan of the mass lesion showing the characteristic low density of fat


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CT scan of the right kidney with a perirenal and retroperitoneal hemorrhage

Discussion:
The hyperechogenicty with ultrasound and the low fat density on the CT scan are characteristic for an angiomyolipoma.

Large angiomyolipomas especialy the large exophytic angiomyolipomas can cause a perirenal and retroperitoneal hemorhage. A spontaneous perirenal hemorrhage is called the Wunderlich's syndrome. The most common cause of the Wunderlich syndrome is an angiomyolipoma. That was also the case in this patient. In cases of large hemorrhagic exophytic angiomyolipomas embolisation or surgery are treatment options. This patient remained stable and untill now has been conservatively treated.

For more angiomyolipomas see

References
Albi G, del Campo L, Tagarro D.Wunderlich's syndrome: causes, diagnosis and radiological management.
Clin Radiol. 2002 Sep;57(9):840-5.

Copyright © Dr. T.S.A. Geertsma, Ziekenhuis Gelderse Vallei, Ede, The Netherlands. All rights reserved.

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