K.E.M.
Radiology
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Department of Radiology
Seth G.S. Medical College and K.E.M. Hospital, Mumbai , India
Case of the Month
Clinical Profile:
A 23-year-old man presented with the complaints of intermittent episodes of suprapubic discomfort for six months
Radiological findings:
Ultrasonogram of the abdomen and pelvis (Fig 1) shows a ballooned right seminal vesicle. The right ureter is dilated. It inserts ectopically into the dilated right seminal vesicle. Proximally it is blind ending. The right kidney is absent. Both epididymis and testes are normal.
Fig. 1 Transabdominal ultrasonogram of abdomen and pelvis
Fig 1a: Axial section of the pelvis shows cystic dilatation of the right seminal vesicle with dependent echogenic content.
Fig 1b : Right parasagittal section of the lower abdomen and pelvis shows dilated and tortuous distal right ureter terminating into the ballooned right seminal vesicle.
Fig 1c : Panoramic view of the right parasagittal section of the abdomen and pelvis shows dilated and tortuous blind ending right ureter terminating into the right seminal vesicle.
Fig 1d : Oblique section in the right hypochondriac region shows empty right renal fossa.
CT Urography (Fig 2) shows the right kidney to be absent. The right seminal vesicle shows cystic dilatation. The right ureter opens into the right seminal vesicle. The left kidney and ureter are normal. The left seminal vesicle and prostate are normal.
Fig. 2 : CT Urography
Fig 2a: Axial section of the abdomen and pelvis in the venous phases shows a homogeneous, nonenhancing, cystic structure in the retrovesical, periprostatic, right paramedian region. The right ureter opens into this cystic structure.
Fig 2b : Coronal section in the excretory phase does not show the right kidney. The left kidney and the left ureter are normal.
MRI abdomen (Fig 3) shows a cyst like structure replacing the right seminal vesicle. The right ureteric remnant in the pelvis opens ectopically into the right seminal vesicle. The left seminal vesicle, the left kidney and the left ureter are normal.
Fig. 3 : MRI Abdomen Sequential coronal sections of T2W sequence a show dilated and tortuous right ureter terminating into the dilated right seminal vesicle. Proximally it is blind ending, terminating at the level of upper border of L5 vertebral body.