Figure 1
fig 1
Fig1:IVU study shows non-visualisation of the left renal system and well opacification of right renal system
Seminal vesicle agenesis with ipsilateral agenesis of kidney and adrenal gland
SectionUroradiology & genital male imaging
Case TypeClinical Cases
AuthorsKumar D, Sheoran RK, Patil S, Makkar A.
Connected authors
40 years, male
Clinical History
Congenital seminal vesicle anomalies are uncommon and often associated with upper urinary tract anomalies due to common embryolocal origin from the mesonephric duct. Here we report a rare case of unilateral seminal vesicle agenesis with the ipsilateral vas deference, renal, ureter and adrenal agenesis.
Imaging Findings
A 40 year old man presented with vague abdominal pain for 2 months. Physical examination and routine laboratory investigations were within normal limits. Ultrasound of abdomen revealed empty left renal fossa with compensatory hypertrophy of right kidney. The left kidney could not be located in any of the ectopic locations also. Left seminal vesicle was also not visualized. Excretory urography was performed which showed non-visualization of left kidney and ureter. Multislice CT showed absence of left adrenal, left kidney, ureter, seminal vesicle and vas deferens.
Discussion
Due to increasing use of CT and MR of the pelvis, more congenital anomalies of seminal vesicles are encountered which are usually associated with upper urinary tract anomalies [1].
Congenital seminal vesicle anomalies result from embryological insult to mesonephric duct which gives rise to ureteric bud also. Kidney and ureter are developed from the ureteric bud. Most distal part of the mesonephric duct (seminal vesicles bud) gives rise to the seminal vesicles [1-3].
Among the various congenital anomalies of seminal vesicles, cystic malformation is the most commonly reported abnormality, which is rarely large enough to cause any clinical significance. This is caused by embryologic insult during 12th week of gestation. Ipsilateral renal agenesis is associated with seminal vesicle cyst in two-third of the patients [1,2,4-6].
Seminal vesicles can be hypoplasic, atrophic or absent, which may be the cause of male infertility [2]. Seminal vesicle agenesis never occurs as isolated entity, which can be unilateral or bilateral. Unilateral agenesis of seminal vesicles is thought to result from aberrant development of mesonephric duct before the seventh week of gestation (before separation of ureteric bud from the mesonephric duct) which is associated with ipsilateral agenesis of kidney, ureter and vas deferens. Seminal vesicle agenesis is always associated with anomalies of vas deferens [1-3]. Our index case represents this rare anomaly which also depicted the absence of ipsilateral adrenal gland (found in 8-10% cases of renal agenesis) [3].
If only seminal vesicle bud fails to develop, then there is absent seminal vesicle and vas deferens with normal kidney and ureter [3]. This probably occurs after 7th week of gestation. The agenesis is likely due to luminal blockade of vas deferens and seminal vesicles by thick secretions [1,3].
The major symptom associated with these conditions is infertility [1], although testicular spermatogenesis is intact [1,3]. Congenital agenesis of seminal vesicle is not surgically correctable and requires no treatment in unilateral cases with a patent contralateral ductal system. In such cases, this condition may go unnoticed as in our index case, where the patient was married with two kids.
Seminal vesicle anomalies are well depicted by CT and MRI which also show associated upper urinary tract anomalies. MRI is a better tool in evaluation of seminal vesicles and associated anomalies due to its multiplanar imaging capability, superior soft tissue contrast, and lack of ionization radiation [1].
Congenital seminal vesicle anomalies result from embryological insult to mesonephric duct which gives rise to ureteric bud also. Kidney and ureter are developed from the ureteric bud. Most distal part of the mesonephric duct (seminal vesicles bud) gives rise to the seminal vesicles [1-3].
Among the various congenital anomalies of seminal vesicles, cystic malformation is the most commonly reported abnormality, which is rarely large enough to cause any clinical significance. This is caused by embryologic insult during 12th week of gestation. Ipsilateral renal agenesis is associated with seminal vesicle cyst in two-third of the patients [1,2,4-6].
Seminal vesicles can be hypoplasic, atrophic or absent, which may be the cause of male infertility [2]. Seminal vesicle agenesis never occurs as isolated entity, which can be unilateral or bilateral. Unilateral agenesis of seminal vesicles is thought to result from aberrant development of mesonephric duct before the seventh week of gestation (before separation of ureteric bud from the mesonephric duct) which is associated with ipsilateral agenesis of kidney, ureter and vas deferens. Seminal vesicle agenesis is always associated with anomalies of vas deferens [1-3]. Our index case represents this rare anomaly which also depicted the absence of ipsilateral adrenal gland (found in 8-10% cases of renal agenesis) [3].
If only seminal vesicle bud fails to develop, then there is absent seminal vesicle and vas deferens with normal kidney and ureter [3]. This probably occurs after 7th week of gestation. The agenesis is likely due to luminal blockade of vas deferens and seminal vesicles by thick secretions [1,3].
The major symptom associated with these conditions is infertility [1], although testicular spermatogenesis is intact [1,3]. Congenital agenesis of seminal vesicle is not surgically correctable and requires no treatment in unilateral cases with a patent contralateral ductal system. In such cases, this condition may go unnoticed as in our index case, where the patient was married with two kids.
Seminal vesicle anomalies are well depicted by CT and MRI which also show associated upper urinary tract anomalies. MRI is a better tool in evaluation of seminal vesicles and associated anomalies due to its multiplanar imaging capability, superior soft tissue contrast, and lack of ionization radiation [1].
Differential Diagnosis List
seminal vesicle agenesis with ipsilateral renal and adrenal agenesis
Final Diagnosis
seminal vesicle agenesis with ipsilateral renal and adrenal agenesis
References
[1] Arora SS, Breiman RS, Webb EM, Westphalen AC, Yeh BM, Coakley FV (2007) CT and MRI of congenital anomalies of the seminal vesicles. AJR Am J Roentgenol 189(1):130-5. (PMID: 17579162)
[2] Parsons RB, Fisher AM, Bar-Chama N, Mitty HA (1997) MR imaging in male infertility.Radiographics 17:627-637. (PMID: 9153701)
[3] Dunnick NR. Text book of uroradiology. Lippincott Williams & Wilkins, 3rdEdition. Chapter 2: Congenital anomalies; p.16,38.
[4] Narlawar RS, Hanchate V, Raut A, Hira P, Nagar A, Chaubal NG (2003) Renal agenesis and seminal vesicle cyst. J Ultrasound Med 22(2):225-8. (PMID: 12562128)
[5] Surana SK, Refai DA, Baj M (2006) Ultrasonography and computed tomographic diagnosis of seminal vesicle cyst associated with ipsilateral renal agenesis. The internal journal of radiology vol 4, number 2.
Case information
| URL: | https://www.eurorad.org/case/7571 |
| DOI: | 10.1594/EURORAD/CASE.7571 |
| ISSN: | 1563-4086 |
Figure 2
fig 2a
Fig 2 (a,b):Axial (a )and coronal (b)CT sections shows absent of left kidney in left renal fossa which is occupied by bowel loops.
Figure 3
fig2b
Fig 2 (a,b):Axial (a )and coronal (b)CT sections shows absent of left kidney in left renal fossa which is occupied by bowel loops.
Figure 4
fig 3a
Fig 3 (a,b):coranal (a) and axial (b) CT sections show absence of left seminal vesicle.
Figure 5
fig 3b
Fig 3 (a,b):coranal (a) and axial (b) CT sections show absence of left seminal vesicle.
fig 1
Fig1:IVU study shows non-visualisation of the left renal system and well opacification of right renal system
fig 2a
Fig 2 (a,b):Axial (a )and coronal (b)CT sections shows absent of left kidney in left renal fossa which is occupied by bowel loops.
fig2b
Fig 2 (a,b):Axial (a )and coronal (b)CT sections shows absent of left kidney in left renal fossa which is occupied by bowel loops.
fig 3a
Fig 3 (a,b):coranal (a) and axial (b) CT sections show absence of left seminal vesicle.
fig 3b
Fig 3 (a,b):coranal (a) and axial (b) CT sections show absence of left seminal vesicle.