Presentation
Vague lower abdominal pain.
Patient Data
Contrast-enhanced and renal excretory phase images of the abdomen show absence of left kidney in renal fossa or other abdominal ectopic sites - representing renal agenesis.
Right kidney is normal in size, location and parenchymal density. On excretory images, there is prompt excretion of contrast into the right collecting system.
There is a tubular cystic structure in the expected location of left ureter with its blind ending superior end (reaching up to L2-3 disc level) representing remnant left ureter.
There is a multilobulated non-enhancing cystic structure in the region of left seminal vesicle - consistent with seminal vesicle cyst. The seminal vesicle cyst was seen indenting the posterolateral wall of the urinary bladder.
Another tubular cystic structure was also seen extending from left seminal vesicle cyst into the midline posterior prostatic urethral wall - representing obstructed dilated left ejaculatory duct.
Case Discussion
A young male with vague lower abdominal pain underwent screening ultrasound, which showed absent left kidney. CT abdomen with intravenous contrast was done for further evaluation.
CT abdomen shows agenesis of the left kidney with cranial blind-ending ureter remnant. Ipsilateral seminal vesicle cyst was seen, causing prominent impression on the posterolateral wall of the urinary bladder. There was also dilatation of left ejaculatory duct, which was seen as a tubular cystic structure extending up to midline posterior prostatic urethra.
The constellation of left renal agenesis, ipsilateral seminal vesicle cyst and obstructed left ejaculatory duct are suggestive of Zinner syndrome.
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