Spontaneous perirenal hematoma (Wunderlich's syndrome) in a man on haemodialysis.

A 52 year old man on chronic haemodialysis presented to the emergency department with right flank pain. There was no history of trauma and no exposure to anticoagulants including heparin during haemodialysis. Abdominal computed tomography (CT) scan without contrast media (Fig. 1) revealed a perirenal haematoma along the anterior aspect of the subcapsular haematoma of right contracted kidney. The arrowhead (Fig. 1) depicts the ruptured site of the renal capsule. Cysts, malignant tumours or angiomyolipomas could not be found in the right kidney. A diagnosis of spontaneous subcapsular and perirenal haematoma – namely, Wunderlich’s syndrome – was established. The patient was treated with blood transfusion alone because angiography failed to disclose active renal haemorrhage. Finally, he was discharged 3 days after this event. In the 19th century, Wunderlich first described this condition of spontaneous renal bleeding with diversion of blood into the subcapsular and/or perirenal spaces. Spontaneous perirenal haematoma is a rare condition in clinical practice, especially in haemodialysis patients.