title: In-flight Valsalva maneuver induced life-threatening Wünderlich syndrome.
abstract: Valsalva maneuver, a preferred method for induction of a complex cardiovascular response, is often performed to relieve ear block during descent in aviation. We described a rare case of Wünderlich syndrome presenting with characteristic clinical and imaging features of ruptured renal angiomyolipoma (AML) induced by a Valsalva maneuver. Renal AML heralded by unbridled hemorrhage is a disastrous entity that can be easily overlooked. Early recognition by exquisite imaging studies along with a raised clinical awareness can forestall unnecessary surgical exploration, preserve renal function, and avoid a life-threatening catastrophe.
authors.affiliation: Division of Nephrology, Department of Medicine, Department of Critical Care Medicine, Tri-Service General Hospital, National Defense Medical Center, Neihu 114, Taipei, Taiwan.
authors.forename: Hung-Wei
authors.initials: HW
authors.lastname: Lin
authors.forename: Yu-Tzu
authors.initials: YT
authors.lastname: Tsao
authors.forename: Yuh-Feng
authors.initials: YF
authors.lastname: Lin
authors.forename: Shih-Hua
authors.initials: SH
authors.lastname: Lin
mesh_terms: D000401:Aircraft; D018207:Angiomyolipoma / Q000175:diagnosis / Q000209:etiology*; D003937:Diagnosis, Differential; D004432:Ear, Middle; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000209:etiology*; D008875:Middle Aged; D013577:Syndrome; D014636:Valsalva Maneuver