Wünderlich syndrome mimicking acute cholecystitis: a case report.

Wünderlich syndrome, or spontaneous non-traumatic renal hemorrhage, is a rare and potentially life-threatening condition. We report the case of a 52-year-old woman presenting with right upper quadrant pain radiating to the lumbar region, bilious vomiting, and positive Murphy's and Giordano's signs, initially suggesting acute biliary disease. Ultrasonography demonstrated cholelithiasis and suspected choledocholithiasis; however, computed tomography urography revealed a large right-sided subcapsular and perirenal hematoma associated with a renal pelvic calculus. Because of the hematoma volume and suspicion of malignancy, nephrectomy was performed. Histopathological examination demonstrated an organized subcapsular hematoma with chronic inflammatory changes and no evidence of neoplasia. This case highlights the diagnostic challenge posed by atypical presentations of Wünderlich syndrome and underscores the essential role of computed tomography in distinguishing spontaneous renal hemorrhage from more common causes of acute abdominal pain.