A 65-year-old woman presented to the emergency department with sudden pain in the left renal fossa radiating to the ipsilateral inguinal region, which did not respond to usual analgesia.
Her personal history included allergy to penicillin, hypothyroidism and dyslipidemia.
Surgical history included two curettage and cervical conization, extraction of cystoderma of the right ovary and correction of right inguinal hernia.
He did not refer recent trauma or anticoagulant treatments.
Physical examination revealed mucocutaneous irritation, mass sensation due to palpation of the left lumbar fossa, with positive renal percussion.
She was afflicted and her blood pressure at admission was 110/60 mmHg.
On admission, blood count showed a hematocrit of 32.1% and hemoglobin of 10.1 g/dl, which progressively decreased and presented hematocrit of 22.8% and hemoglobin of 7.5 g/dl within hours.
High-resolution computed tomography in the left renal space showed a heterogeneous mass of approximately 17 × 10 cm in diameter, with active left renal localization, of mainly fat adjacent lineage, producing a ruptured cortical bone.
Bleeding inside the tumor mass was also observed.
The radiological diagnosis was ruptured left renal angiomyolipoma with active bleeding.
The clinical diagnosis was Wünderlich syndrome or retroperitoneal hemorrhage secondary to spontaneous rupture of left renal angiomyolipoma.
Treatment consisted of left nephrectomy.
The anatomopathological study macroscopically described a piece of left nephrectomy, weighing 360 g, measuring 16 × 10 × 3.5 cm and containing within it a mass of 16 × 6 cm that occupied the largest part of the adipose tissue.
Microscopically, the tumor was intrarenal and consisted of mature adipose tissue, scarce vascular component and occasional muscle bundles.
Immunohistochemistry was negative for HMB 454.
Histopathological diagnosis was fragmented renal angiomyolipoma.
