Role of magnetic resonance imaging in evaluation of ejaculatory duct in Zinner’s syndrome: case series of five patients and review of the literature

Abstract

Background Zinner's syndrome is a mesonephric duct anomaly characterized by unilateral renal agenesis, ipsilateral seminal vesicle cyst, and ipsilateral ejaculatory duct obstruction due to insult occurred at urogenital tract embryogenesis during the first trimester. In the third and fourth decades of life, it is frequently diagnosed when patients begin to be symptomatic, such as lower urinary tract symptoms, infertility and painful ejaculation. Case presentation Herein we illustrate case review including five patients diagnosed as Zinner’s syndrome, three of them complaining from infertility; however, the remaining two cases were fertile and incidentally diagnosed. Conclusions Radiological investigations play significant role in the diagnostic and management processes including US, CT and MRI for detecting ipsilateral renal agenesis and unilateral seminal vesicles dilatation, but evaluation of ejaculatory duct can be done only by MRI and transrectal ultrasound; however, the latter may be sometimes nonconclusive or intolerable by patients, so MRI is considered the golden modality with its high capability to assess the lower male genital tract which played a significant role in our case series starting with detection of the presence or absence of the ejaculatory duct obstruction as well as the high delineation of the origin and nature the seminal vesicle cyst including also its size and content and finally by detection of the communication between ureteral bud and the seminal vesicles cystic dilatation.

The role of radiology in diagnosis of Zinner syndrome in a young man with scrotal pain

“…MRI is useful in identifying seminal vesicle cysts and has a low signal intensity on T1 images and a high signal intensity on T2 images. There can be a high signal intensity on T1 due to hemorrhage or the presence of proteinaceous fluid [10] .…”