urinary: ur16

URINARY: UR16

HEMORRHAGIC CYST OF VAS DEFERENS

AMPULLA: A REPORT CASE

L. EL ASSASSE, S. BOUTACHALI, F. AMRAOUI, A. AJANA, L. SBIHI. Radiology service, Avicenne hospital, Rabat, Morocco

INTRODUCTION: The cyst of the vas deferens ampulla is

a rare pathology, often of congenital origin.

The hemorrhagic character usually occurs after a trauma.

We report in this work a case of hemorrhagic cyst of the vas deferens ampulla illustrated by ultrasound and MRI.

OBSERVATION: A 29-year-old young man without

significant medical or surgical history, presented for last year a pelvic pain reported 2 months after a pelvic trauma.

A pelvic ultrasound and an MRI were performed.

RESULTS AND DISCUSSION: The ultrasound found a supraprostatic

cyst formation, lateralized to the left, well limited, with uniform anechoic content, measuring 45x40 mm.

In addition, renal ultrasound revealed agenesis of the left kidney.

Ultrasound shows a supraprostatic cyst formation, lateralized to the left, well limited, with uniform anechoic content, measuring 45x40 mm.

On MRI: Presence of a cystic mass roughly rounded, well

defined in the left vas deferens ampulla, with hemorrhagic content (homogeneous hyperintense signal on T1 and hypointense on T2), surrounded by a very thin wall, did not enhancing after gadolinium injection.

This mass measuring 44x46x50mm, and its anterior surface comes in contact with the bladder, it pushes back the rectum and laterally seminal vesicles.

RESULTS AND DISCUSSION:

The left seminal vesicle is repressed by the lesion and also presents a hemorrhagic content.

The ejaculatory duct is slightly dilated with hemmorrhagic signal.

No stones visible in the ejaculatory duct or vas deferens ampulla or in the seminal vesicle.

Absence of utricular or Mullerian cyst.

RESULTS AND DISCUSSION:

Sagittal T1 before and after gadolinium injection and T2 MRI: Mass in the left vas deferens ampulla; it presents a hyperintense signal on T1 and hypointense on T2, and is not enhanced after gadolinium injection in favor of hemorrhagic cyst.

Axial T1 before and after gadolinium injection and T2 MRI: Mass in the left vas deferens ampulla; it presents a hyperintense signal on T1 and hypointense on T2, and is not enhanced after gadolinium injection in favor of hemorrhagic cyst.

Cysts of urogenital tract are due to defective resorption of Müller or Wolff channels in life in utero.

Renal agenesis is often associated.

Hemorrhagic character may occur following trauma as in our patient.

RESULTS AND DISCUSSION:

CONCLUSION: Echography in particular endorectal

ultrasonography allows the diagnosis of urogenital tract cyst.

However, MRI may be indicated for voluminous cyst which limits and relations are difficult to specify.

REFERENCES: El Ghazouli N, Amraoui F, Skalli A,

Chikhaoui N. Evaluation échographique de l’infertilité masculine. J Maroc Urol 2008; 10: 7-11.

Fisch H, Kang YM, Johnson CW, Goluboff ET. Ejaculatory duct obstruction. Curr Curr Opin Urol 2002; 12: 509-15.

Meacham RB, Townsend RR, Drose JA. Ejaculatory duct obstruction: Diagnosis and treatment with transrectal sonography. AJR 1995; 165: 1463-66.