The authors made an up-to-date review of the literature concerning the management of Zinner's syndrome and evaluated a young patient with Zinner's syndrome who had presented with urinary and ejaculatory complaints. Physical examination and transrectal ultra-sonography showed a 7.0 cm right seminal vesicle cyst. Magnetic resonance imaging (MRI) confirmed the diagnosis of Zinner's syndrome. Oligoasthenoteratozoospermia was present at the two seminal analyses. Symptomatic improvement was achieved with conservative measures. Actually, the patient is still on a follow-up programme. The diagnosis is usually established at the age of increased sexual activity. Patients may be asymptomatic or present pain, irritative urinary or ejaculatory symptoms and infertility. MRI has proved to be the best imaging examination. Treatment should be adapted to symptoms, surveillance being the best option in the absence of clinical manifestations. Surgical approach may be adequate when conservative measures prove ineffective. Zinner's syndrome should be suspected if a male young patient presents with unilateral renal agenesis and pelvic complaints and has a supraprostatic mass on digital rectal examination. The initial approach should be medical, but invasive procedures may be the only way to solve the patient's complaints. Nowadays, laparoscopic and robotic techniques must replace the open surgical approach.

Zinner’s syndrome: an up-to-date review of the literature based on a clinical case

PURPOSE: To determine whether the perirenal spaces communicate across the midline and with the pelvic extraperitoneal spaces. MATERIALS AND METHODS: Helical CT was used to guide the sequential injection of 100-mL intravenous boluses of dilute contrast medium, up to 300 mL, into the perirenal space of eight embalmed cadavers (three male, five female; mean age at death, 82 years; range, 72–93 years), with four left-sided and four right-sided injections. All images were acquired after the final injection (300 mL total) to facilitate coronal and sagittal reconstruction of relevant images. All images were reviewed to assess the flow pathways of contrast medium from the perirenal space to other retroperitoneal spaces. RESULTS: In three cadavers that received left perirenal space injections and in two cadavers that received right perirenal space injections, communication was seen with the contralateral perirenal space through an area anterior to the aorta and inferior vena cava. In three cadavers that received r...

Helical CT evaluation of the perirenal space and its boundaries: a cadaveric study.

Magnetic Resonance Imaging of Seminal Vesicle Cyst Associated with Ipsilateral Urinary Anomalies

The purpose of this study was to evaluate prospectively, whether integrated 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography-computed tomography (FDG-PET-CT) is more accurate for determination musculoskeletal tumors compared with separate interpretation of CT and FDG-PET, because most of the current clinical data come from patients studied with PET. Eighty patients with newly diagnosed musculoskeletal tumors underwent FDG-PET-CT. CT, FDG-PET, and FDG-PET-CT were interpreted separately to determine the performance of each imaging modality. Assuming that equivocal lesions are benign, performance of diagnostic tests was as follows: sensitivity, specificity and accuracy for CT alone was 81, 84, 83%, for PET 71, 82, 76, and for PET-CT 80, 83 and 86%. Assuming that equivocal lesions are malignant, sensitivity, specificity, and accuracy for CT was 61, 100, 70%, for PET 69, 100, 79, and for PET-CT 69, 100 and 79%. Combined FDG-PET-CT reliably differentiates soft tissue and bone tumors from benign lesions. The value of the information provided by FDG-PET-CT for planning surgical procedures must be evaluated in further studies.

Integrated FDG-PET-CT: its role in the assessment of bone and soft tissue tumors.

Seminal-vesicle cysts associated with renal agenesis are rare congenital or acquired lesions. We report a case of seminal-vesicle cyst causing urinary retention in a young patient with right renal agenesis who was treated successfully with transurethral unroofing. Magnetic resonance imaging aided us in making the conclusive diagnosis without the need for any invasive investigations.

Endoscopic management of seminal-vesical cyst with right renal agenesis causing acute urinary retention: Case report.

Congenital seminal vesicle cysts associated with ipsilateral renal agenesis or dysplasia are rare malformations. Even though they are more often diagnosed today due to the introduction of advanced, sectional imaging techniques as CT and MRI, no reliable data about the prevalence of this malformation are available. This study reports seven consecutive cases, with long-term follow-up in five cases (26-119 months, mean 52 months). All patients underwent sonography, excretory urography, CT and MRI. Only two of seven patients presented nonspecific symptoms of the lower urinary tract; five were asymptomatic. In all cases sonography revealed the cystic character of the retrovesical enlargement. The anatomy of the lower pelvis was most accurately shown on MRI, which depicted the ectopic insertion of the ureter into the seminal vesicle in five cases. Cysts demonstrated high signal intensities in T1- and T2-weighted spin-echo images. In five cases the CT density was over 40 HU. Whereas one patient (15 years) presented significant enlargement of the cysts 10 years after primary diagnosis with compression of the urinary bladder, four patients showed no changes of their malformation in the follow-up examinations. The present data therefore support the concept of treating only symptomatic patients.

[Seminal vesicle cysts associated with ipsilateral renal agenesis. Diagnosis, and long-term clinical course].

Kongenitale Samenblasenzysten mit ipsilateraler Nierenagenesie oder -dyplasie sind seltene angeborene Misbildungen. Seit Einfuhrung moderner Schnittbildverfahren werden sie jedoch zunehmend haufiger diagnostiziert. Dennoch fehlen bislang genaue Angaben uber die Pravalenz dieses Misbildungsmusters. Diese Studie berichtet uber 7 konsekutive Falle und dokumentiert in 5 Fallen Langzeitbeobachtungen (26–119 Monate, Mittel 52 Monate). Von allen Patienten liegen Ultraschalluntersuchungen, Ausscheidungsurographien sowie Computer- und Kernspintomographien vor. Nur 2 von 7 Patienten wiesen unspezifische Symptome des unteren Harntraktes auf, alle anderen waren asymptomatisch. Von allen bildgebenden Verfahren zeigte die Kernspintomographie am genausten die Veranderungen im kleinen Becken und ihre Beziehungen zum Urogenitalsystem. Die Zysten wiesen eine hohe Signalintensitat in T1- und T2-gewichteten Spin-Echo-Sequenzen auf. Computertomographisch fanden sich in 5 Fallen Dichtewerte uber 40 HE. Wahrend ein Patient (15 Jahre alt) 10 Jahre nach Erstdiagnose eine erhebliche Vergroserung der Zysten mit Verdrangung der Harnblase aufwies, zeigten 4 Patienten bei der Nachuntersuchung keine Veranderung der Fehlbildung. Die vorliegenden Daten stutzen somit das Konzept, nur symptomatische Patienten zu therapieren.

Samenblasenzysten bei ipsilateraler Nierenagenesie Bildgebende Diagnostik, Klinik und Langzeitverlauf

Samenblasenzysten bei ipsilateraler Nierenagenesie

Soft tissue tumors. I. Classification and staging

119 MR-examinations of both tibiae, knees and the lower part of both femur were performed in 41 children suffering from bone marrow disease (27 ALL, 4 AML, 3 NHL, 1 agranulocytosis, 6 anaemia). T1- and T2-spin-echo sequences and a T2-gradient-echo sequence were used. Bone marrow changes in leukaemia were diffuse before therapy and patchy after therapy. Due to their different signal in T2-weighted images, differentiation of the post-therapeutic patchy findings into infiltrations, fibrosis, necrosis and siderosis seems to be possible. In future, MRI will be the method of choice for screening and controlling bone marrow disease if the examination time is shortened by using only a T1-spin-echo sequence and a T2-gradient-echo sequence.

Zur Diagnostik von Knochenmarkläsionen im MR-Tomogramm bei Kindern mit Erkrankungen des hämatopoetischen Systems unter besonderer Berücksichtigung der posttherapeutischen Veränderungen

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