Zinner syndrome: A mesonephric duct anomaly with renal agenesis, ipsilateral seminal vesicle cyst, and ejaculatory duct obstruction

Abstract

Anomalies of the mesonephric duct are associated with a combination of renal agenesis/dysgenesis, ejaculatory duct obstruction, and seminal vesical cyst, called Zinner syndrome. We present a case of this rare syndrome in a young male patient, who initially presented with urinary symptoms. The relevant embryology and diagnostic modalities are discussed.

Keywords: Ejaculatory duct obstruction; Mesonephric duct abnormality; Seminal vesicle cyst; Zinner syndrome.

Fig. 1

Ultrasonographic images of pelvis-transabdominal (a) and transrectal (b) examinations reveal cystic lesion (C) indenting upon the posterior surface of urinary bladder (UB). The transrectal view reveals multiple echoes in it.

Fig. 2

Intravenous pyelogram shows absent right kidney (∗) with normally placed left kidney (@), radiolucent indentation (#) upon the urinary bladder in the excretory phase.

Fig. 3

Contrast-enhanced CT scan images a and b showing absent right kidney with absent ($) right renal artery, suggestive of congenital agenesis; c shows a hypodense pelvic lesion (@) indenting upon the posterior surface of urinary bladder (UB).

Fig. 4

Sagittal T1-weighted gradient (a) and T2 TSE (b) images showing T1 and T2 hyperintense contents in the seminal vesicle cyst (#); T2W axial images (c) - dilated vas deferens (yellow arrow) and (d) - dilated right seminal vesicle tubules (yellow arrow) and normal sized seminal vesicle on the left side (red arrow); (e) -T2 sagittal, (f)-T2 coronal - showing normal sized left ejaculatory duct.