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CT and MRI of Congenital Anomalies of the Seminal Vesicles

¹ All authors: Department of Radiology, University of California, San Francisco, 505 Parnassus Ave., Rm. M-372, Box 0628, San Francisco, CA 94143-0628.

View larger version (120K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —32-year-old man with symptoms of appendicitis. Axial contrast-enhanced CT scan through pelvis shows absence of left seminal vesicle as incidental finding. Normal right seminal vesicle (arrow) is visible.

View larger version (141K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —32-year-old man with symptoms of appendicitis. Coronal reformation shows associated ipsilateral agenesis of left kidney. Normal right kidney is visible. Again note absence of left seminal vesicle, but normal right seminal vesicle (arrow) is seen.

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —31-year-old man with hematuria. Axial unenhanced CT scan shows large seminal vesicle cyst (arrow) to be well-defined low-attenuation mass posterior to bladder and arising from seminal vesicle.

View larger version (152K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —31-year-old man with hematuria. Axial T1-weighted MR image with fat saturation shows left seminal vesicle cyst (arrow) of high T1 signal intensity, presumably due to proteinaceous or hemorrhagic content.

View larger version (162K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —31-year-old man with hematuria. Axial T2-weighted MR image shows cyst (arrow) has signal intensity near that of fluid.

View larger version (149K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D —31-year-old man with hematuria. Axial T1-weighted MR image after IV gadolinium administration shows that cyst (arrow) does not enhance.

View larger version (131K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —34-year-old man with known autosomal dominant polycystic kidney disease, infertility, and recurrent epididymitis. In axial unenhanced CT scan, bilateral seminal vesicle cysts (arrows) are visible as multilobular, well-circumscribed, low-attenuation structures.

View larger version (139K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —34-year-old man with known autosomal dominant polycystic kidney disease, infertility, and recurrent epididymitis. Coronal reformatted image shows typical appearance of autosomal dominant polycystic kidney disease involving both kidneys (arrows).

View larger version (128K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —Male fetus at 30 weeks of gestation. MRI was performed for further evaluation of abnormal prenatal sonography. Sagittal T2-weighted single-shot fast spin-echo MR image (TR/TE, infinite/96) shows two cystic, fluid-filled masses in fetal pelvis. At postnatal surgery, anterior mass (white arrow) was found to be bladder, and posterior mass (black arrow) was dilated distal ureter inserting into dilated seminal vesicle.

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —Male fetus at 30 weeks of gestation. MRI was performed for further evaluation of abnormal prenatal sonography. Coronal T2-weighted MR image shows ipsilateral multicystic dysplastic kidney (arrow) adjacent to dilated ureter and seminal vesicle (asterisk).

View larger version (167K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —22-year-old man with chronic pelvic pain. Axial T2-weighted MR image shows dilatation of right seminal vesicle (arrow). Fluid level is also present, presumably reflecting proteinaceous content or prior hemorrhage.

View larger version (162K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —22-year-old man with chronic pelvic pain. Coronal T2-weighted MRI image shows that cystic dilatation is due to communication with markedly atrophic and hydronephrotic pelvic right kidney (arrow).

View larger version (131K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —34-year-old man with tongue cancer. Coronal reformatted contrast-enhanced CT image shows incidental left renal agenesis and dilated left ureter (arrow) draining into cystic ipsilateral seminal vesicle (asterisk).

View larger version (145K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —34-year-old man with tongue cancer. Axial T2-weighted MR image shows connection between ureter and seminal vesicle (arrow).

View larger version (185K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7A —68-year-old man with hematuria and bladder cancer. Axial delayed contrast-enhanced CT scan shows fluid-filled structure (arrow) in right hemipelvis could be mistaken for seminal vesicle cyst.

View larger version (120K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7B —68-year-old man with hematuria and bladder cancer. Maximum-intensity-projection T2-weighted MR urographic image shows that fluid-filled structure in right pelvis is dilated ureter (arrow).

View larger version (117K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7C —68-year-old man with hematuria and bladder cancer. Axial delayed contrast-enhanced CT section at higher level than A shows horseshoe kidney with markedly dysplastic right-sided moiety (arrow). Surgery confirmed that fluid-filled structure in right hemipelvis seen in A was a dilated ureter arising from a dysplastic right-sided moiety of a horseshoe kidney, and also showed right ureter draining into prostate, with bilateral absence of seminal vesicles.

View larger version (130K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8 —Contrast-enhanced axial CT scan in 84-year-old man with history of prior nephrectomy for renal cell carcinoma. Large fluid-filled bladder diverticulum (asterisk) arising off bladder posteriorly could be mistaken for seminal vesicle cyst.

View larger version (172K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9 —Axial T2-weighted MR image in 72-year-old man with prostate cancer. Large midline müllerian duct cyst (arrow) is seen posterior to prostate. Midline location is typical of such cyst and is a useful feature for differentiating from seminal vesicle cyst.

View larger version (115K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10 —Endorectal seminal vasography (or vesiculography) in 42-year-old man with infertility. This study is helpful in confirming that periprostatic structure is due to dilated ejaculatory duct (arrow) upstream from obstruction of entrance of ejaculatory duct into prostatic urethra. Injection of contrast material under endorectal sonographic guidance both opacifies dilated obstructed duct and confirms that it is obstructed, because contrast material does not pass into prostatic urethra.

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