Department of Urology, Korea University College of Medicine, Seoul, Republic of Korea.
Department of Emergency Medicine, Korea University College of Medicine, Seoul, Republic of Korea.
Am J Emerg Med. 2019 Jan;37(1):45-47. doi: 10.1016/j.ajem.2018.04.045. Epub 2018 Apr 21.
This study aimed to analyze the characteristics, etiology, and treatment of a series of patients with spontaneous perirenal hemorrhage (Wunderlich syndrome [WS]).
We retrospectively reviewed the records of 26 patients hospitalized for WS in a tertiary urological center between 2011 and 2018. All patients were evaluated for perirenal hemorrhage observed on computed tomography (CT) in the emergency department. Clinical variables (age, underlying diseases, symptoms, shock, and hospitalization period), laboratory test results, and radiological and pathological results were reviewed.
The series included 28 events from 26 patients with a mean follow-up period of 20.2 ± 18.0 months. Flank pain was most common symptoms (92%). Twelve patients (46%) had visible renal lesions and associated hematoma and 14 only showed perirenal hematoma. In six patients with shock (systolic blood pressure < 90 mm Hg), 2 underwent emergency angioembolization. Twelve patients (46%) underwent exploration and total nephrectomy. In the final diagnosis, 4 cases of renal cell carcinoma, 3 of angiomyolipoma, 4 of simple renal cyst, 2 of acquired cystic kidney disease, 4 of sarcoma or other malignancy, 4 of chronic pyelonephritis, and 5 of idiopathic WS were observed. Patient age was associated with prediction of renal cell carcinoma in the patients with WS.
Renal masses are the main cause of WS, and CT is the diagnostic procedure of choice. Old age is a possible risk factor for renal cell carcinoma in etiology of WS. Surgical treatment is preferred in patients diagnosed with renal malignancy and in cases of hemodynamic instability.
本研究旨在分析一系列自发性肾周出血（Wunderlich 综合征[WS]）患者的特征、病因和治疗方法。
我们回顾性分析了 2011 年至 2018 年期间在一家三级泌尿外科中心因 WS 住院的 26 例患者的病历。所有患者均因急诊 CT 检查发现肾周出血而接受评估。我们回顾了临床变量（年龄、基础疾病、症状、休克和住院时间）、实验室检查结果以及影像学和病理学结果。
该系列研究包括 26 例患者的 28 次事件，平均随访时间为 20.2±18.0 个月。最常见的症状是腰痛（92%）。12 例患者（46%）可见肾脏病变并伴有血肿，14 例仅显示肾周血肿。在 6 例休克患者（收缩压<90mmHg）中，2 例行紧急血管造影栓塞术。12 例患者（46%）行探查和全肾切除术。最终诊断为肾细胞癌 4 例，血管平滑肌脂肪瘤 3 例，单纯性肾囊肿 4 例，获得性囊性肾病 2 例，肉瘤或其他恶性肿瘤 4 例，慢性肾盂肾炎 4 例，特发性 WS 5 例。患者年龄与 WS 患者肾细胞癌的预测有关。
肾肿块是 WS 的主要原因，CT 是首选的诊断程序。年龄较大可能是 WS 病因中肾细胞癌的一个潜在危险因素。对于诊断为肾恶性肿瘤和存在血流动力学不稳定的患者，手术治疗是首选。
