November 2007

Lesion in the lowerpole of the right kidney

Clinical Info

Sudden pain in the right flank

Ultrasound Images & Clips

51 year old female, Sudden pain in the right flank

Longitudinal image of the right kidney with an inhomogeneous mass in the lowerpole of the kidney with a hyperechoic rim and a perirenal effusion
Longitudinal image of the right kidney with an inhomogeneous mass in the lowerpole of the kidney with a hyperechoic rim and a perirenal effusion
Longitudinal image of the kidney with a hyperechoic rim and a perirenal effusion
Longitudinal image of the kidney with a hyperechoic rim and a perirenal effusion
Transverse image of the kidney with a hyperechoic rim and a perirenal effusion
Transverse image of the kidney with a hyperechoic rim and a perirenal effusion
Detail of the mass lesion with very high echogenicity
Detail of the mass lesion with very high echogenicity
The lesion is poorly vascularized
The lesion is poorly vascularized
CT scan of the mass lesion showing the characteristic low density of fat
CT scan of the mass lesion showing the characteristic low density of fat
CT scan of the right kidney with a perirenal and retroperitoneal hemorrhage
CT scan of the right kidney with a perirenal and retroperitoneal hemorrhage

Conclusion

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.

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


Details

  • Sex: Female
  • Age: 51

Created with

  • Hitachi Ultrasound System