Wunderlich Syndrome Caused by Spontaneous Rupture of Renal Angiomyolipoma in the Third Trimester of Pregnancy: Endovascular Management With Fetal Preservation—A Case Report and Literature Review

Abstract

Renal angiomyolipoma (AML) are benign tumors incidentally diagnosed during routine radiologic images; nonetheless, AML rupture is uncommon and has been associated with fatal consequences, demanding prompt intervention, especially during pregnancy with symptoms of Wunderlich's syndrome (WS) and atrophied contralateral kidney. We report a 30-year-old pregnant woman who presented with gross hematuria and hypovolemic shock in her seventh month of pregnancy. Magnetic resonance imaging revealed a 15 × 13.5 × 16 cm AML mass in the left kidney, a 5 × 6 cm intrarenal pseudoaneurysm, and a massive retroperitoneal hematoma with an atrophied contralateral right kidney. After achieving hemodynamic stability, selective renal arterial embolization was performed with a successful outcome. She subsequently delivered her baby via cesarean section without complications. In conclusion, although WS due to AML rupture is rare during pregnancy, accurate diagnosis and prompt endovascular treatment should be pursued in cases involving a solitary kidney and associated comorbid conditions to safeguard the lives of both the patient and the baby, stabilize renal function, and prevent catastrophic complications.