Spontaneous perirenal hematoma - foreshadowing of an impending renal cell carcinoma - does it need close surveillance? A case report and literature review

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Renal cell carcinoma classically presents as a triad of hematuria, loin pain, and a palpable mass. Sometimes it may present as an incidental finding, whereas spontaneous renal hemorrhage or Wunderlich syndrome is a rare presentation of renal cell carcinoma. We present a clinical case of 51 years old gentleman who presented with right flank pain with no other significant history. Computed tomography scan showed right perirenal hemorrhage with no abnormality in the kidney. A drain was placed and the hematoma was evacuated. The patient was discharged. On follow-up at 6 months, he was asymptomatic but found to have a renal lesion on ultrasound, which was evaluated with computed tomography scan and partial nephrectomy was done and histopathology was suggestive of papillary renal cell carcinoma. Renal cell carcinoma being an aggressive tumor, any spontaneous perirenal hemorrhage with unknown etiology mandates a strict follow-up with prompt imaging for concerns of impending renal cell carcinoma.