EURORAD ESR

Case 9872

An uncommon idiopathic case of Wunderlich syndrome

Author(s)
Tonolini Massimo, MD.

"Luigi Sacco" University Hospital,
Radiology Department;
Via G.B. Grassi 74 20157 Milan, Italy;
Email:mtonolini@sirm.org
 
Patient
female, 86 year(s)
 
 
  • Figure 1
    Emergency bedside ultrasound
     

    A large (8-cm maximum diameter) hypo-anechoic collection is observed abutting the left kidney.

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;

    The contralateral right kidney shows a similar, moderate diffuse reduction of parenchymal thickness and some small cysts.

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;
     
     
  • Figure 2
    Initial CT examination
     

    Unenhanced images (a,b) show hyperdense (attenuation 60 HU) perinephric hemorrhagic collection surrounding the left kidney.

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;

    Unenhanced images (a,b) show hyperdense (attenuation 60 HU) perinephric hemorrhagic collection surrounding the left kidney.

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;

    CT-angiography (c,d) confirms perinephric haematoma without compression of the renal parenchyma. Renal masses and contrast extravasation indicating active bleeding are not appreciable.

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;

    CT-angiography (c,d) confirms perinephric haematoma without compression of the renal parenchyma. Renal masses and contrast extravasation indicating active bleeding are not appreciable.

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;

    Coronal (e) and sagittal (f) reformatted images depict the entire extent of the perinephric haematoma (2.5 cm maximum thickness), without renal masses and bleeding arterial lesions.

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;

    Coronal (e) and sagittal (f) reformatted images depict the entire extent of the perinephric haematoma (2.5 cm maximum thickness), without renal masses and bleeding arterial lesions.

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;
     
     
  • Figure 3
    Follow-up CT after 5 days
     

    Unenhanced (a) and corresponding contrast-enhanced (b) images depict persistent, well-demarcated perirenal haematoma with slightly reduced attenuation values.

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;

    Unenhanced (a) and corresponding contrast-enhanced (b) images depict persistent, well-demarcated perirenal haematoma with slightly reduced attenuation values.

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;
     
     
  • Figure 4
    Repeat CT after 3 months from hospital discharge
     

    Axial (a,b) and coronal reformatted (c) images show stabilised evolution of haematoma as a hypodense collection with demarcated, thick wall abutting the kidney. Confirmed absence of underlying lesions.

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;

    Axial (a,b) and coronal reformatted (c) images show stabilised evolution of haematoma as a hypodense collection with demarcated, thick wall abutting the kidney. Confirmed absence of underlying lesions.

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;

    Axial (a,b) and coronal reformatted (c) images show stabilised evolution of haematoma as a hypodense collection with demarcated, thick wall abutting the kidney. Confirmed absence of underlying lesions.

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;
     
     
A large (8-cm maximum diameter) hypo-anechoic collection is observed abutting the left kidney.
 
The contralateral right kidney shows a similar, moderate diffuse reduction of parenchymal thickness and some small cysts.
 
Unenhanced images (a,b) show hyperdense (attenuation 60 HU) perinephric hemorrhagic collection surrounding the left kidney.
 
Unenhanced images (a,b) show hyperdense (attenuation 60 HU) perinephric hemorrhagic collection surrounding the left kidney.
 
CT-angiography (c,d) confirms perinephric haematoma without compression of the renal parenchyma. Renal masses and contrast extravasation indicating active bleeding are not appreciable.
 
CT-angiography (c,d) confirms perinephric haematoma without compression of the renal parenchyma. Renal masses and contrast extravasation indicating active bleeding are not appreciable.
 
Coronal (e) and sagittal (f) reformatted images depict the entire extent of the perinephric haematoma (2.5 cm maximum thickness), without renal masses and bleeding arterial lesions.
 
Coronal (e) and sagittal (f) reformatted images depict the entire extent of the perinephric haematoma (2.5 cm maximum thickness), without renal masses and bleeding arterial lesions.
 
Unenhanced (a) and corresponding contrast-enhanced (b) images depict persistent, well-demarcated perirenal haematoma with slightly reduced attenuation values.
 
Unenhanced (a) and corresponding contrast-enhanced (b) images depict persistent, well-demarcated perirenal haematoma with slightly reduced attenuation values.
 
Axial (a,b) and coronal reformatted (c) images show stabilised evolution of haematoma as a hypodense collection with demarcated, thick wall abutting the kidney. Confirmed absence of underlying lesions.
 
Axial (a,b) and coronal reformatted (c) images show stabilised evolution of haematoma as a hypodense collection with demarcated, thick wall abutting the kidney. Confirmed absence of underlying lesions.
 
Axial (a,b) and coronal reformatted (c) images show stabilised evolution of haematoma as a hypodense collection with demarcated, thick wall abutting the kidney. Confirmed absence of underlying lesions.
 
 
 
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