Presentation
Secondary infertility, ultrasound to rule out blocked ejaculatory ducts.
Patient Data
The seminal vesicles maintain their bow-tie shapes, however, with mild symmetrical reduction in their sizes (hypoplasia). The right seminal vesicle has a mean anterior-posterior (AP) diameter of 0.46 cm and measures 1.87 cm in length while the left has a mean AP diameter of 0.50 cm and measures 1.93 cm in length. The vas deferens are barely visualized proximally as well. No vesicles' calcific foci or masses or cysts. No pelvic adenopathy.
The prostate gland grossly looks normal and weighs 24.04 grams = TRUS measurement with homogeneous parenchymal echotexture. The gland is not hypervascular. No gross nodular or calcific changes.
The urinary bladder is normal in capacity and wall outline with no luminal masses or bladder diverticulum, with a pre-micturition capacity of 658.57 cc and an immediate post-void volume of 58.67 cc.
Case Discussion
Ultrasound features pointing towards symmetrical seminal vesicles hypoplasia as possibly the cause of the presenting secondary infertility. Existing literature shows that the length of the seminal vesicles in adults should range from 3.6 to 7.6 cm and the width at least up to 1.5 cm in order not to be considered hypoplastic1,2.
Some literature posits that if the seminal vesicles have maximal widths greater than 1.5 cm and with numerous amount of seminal fluid/sperm, this may be used as a diagnosis for ejaculatory duct obstruction, even if not in all cases3. Again, the usual honeycomb/septated appearance of the seminal vesicles is conspicuously missing.
The ejaculatory ducts (vas deferentia) are not well visualized suggesting hypoplasia or vasal agenesis.