Wunderlich syndrome (WS) is a rare , potentially fatal condition, characterized by spontaneous renal or perinephric hemorrhage, without history of known trauma. WS is named after the German physician Carl Reinhold August Wunderlich (1815-1877), who published the first clinical case, in 1856. [6]  

The typical clinical presentation of WS consists of the classic Lenk's triad: acute flank pain, flank mass, and hypovolemic shock , although in clinical practice it is actually seen in only 20% of cases. However, clinical manifestations can be varied and nonspecific. The majority of patients with WS present in the ED, with an atypical, abdominal pain. [1]   

Renal neoplasms, such as angiomyolipomas (AMLs) and clear cell renal cell carcinomas (RCCs) represent the most common causes of WS, contributing to approximately 60%–65% of all cases. Uncommon causes of WS include renal vascular diseases (aneurysms or pseudoaneurysms, arteriovenous malformations or fistulae, renal vein thrombosis, and vasculitis syndromes) , accounting for 20%–30% of cases and even more atypical ones, such as renal infections, cystic disease, calculi, kidney failure, and coagulation disorders. [1-6]

Cross-sectional imaging and particularly multiphasic CT in the ED, has become indispensable for the detection, characterization and optimal management of the underlying causes of WS.