Presentation
Progressive perineal pain. Request to exclude a right inguinal hernia.
Patient Data
The right renal bed is empty and no evidence of an ectopic right kidney.
There is compensatory hypertrophy of the left kidney at 12.9cm in length.
There is an eccentric, multicystic, septated, avascular, intra-pelvic lesion adjacent to the prostate and projecting into the bladder. There is no intracystic debris or haemorrhage.
There are no inguinal hernias bilaterally.
Multiphasic CT imaging confirms the absence of the right kidney and a hypertrophied left kidney.
There is a central, multicystic, septated, avascular, intra-pelvic mass lesion. This appears larger right of the midline and projects into the bladder base as per the ultrasound appearance and findings. The lesion is retrovesicular and superior to the prostate. There is no intralesional haemorrhage and no associated calcification or fat.
There is a non-opacified and atretic right ureter, opening into the right seminal vesicle.
Although an insensitive assessment on CT, the right testis appears smaller than the left, with a right hydrocoele. The right vas deferens is dilated in comparison to the left.
CT imaging is otherwise normal.
Case Discussion
A case of a unilateral, right renal agenesis and suspected congenital seminal vesicle cysts as demonstrated. There is a known association between renal agenesis and ipsilateral seminal vesicle cyst(s)1.2. There are multiple reasons for the presentation of congenital seminal vesicle cysts in these patients due to associated urogenital anomalies including ectopic ureteric insertion, ductus deferens agenesis and ejaculatory duct atresia/obstruction1.2. In this instance, a linear, cystic structure is identified on the delayed imaging suggesting an atretic and ectopic ureter inserted into the right seminal vesicle/ right vas deferens. The well-appreciated inguinal fullness on the right is due to the dilated and likely obstructed right vas deferens. These features therefore suggest a case of Zinner syndrome consisting of unilateral right renal agenesis, ipsilateral seminal vesicle cysts and probable ejaculatory duct obstruction.
The broad differential diagnosis based on the ultrasound appearance included a pelvic ectopic kidney and obstruction; hydroureter, with and without an ectopic ureterocoele; an irregular mesenteric/ duplication cyst, lymphangioma, and Mullerian duct cysts.
The multiphasic CT imaging confirms an empty right renal bed and the absence of an ectopic kidney. The retrovesicular cystic lesion is eccentrically larger on the right and at the level of the seminal vesicles.
The patient is yet to present for an MRI study as recommended.
Unable to process the form. Check for errors and try again.