Contributed by
Vanderbilt Health
Jeffery Anderson, M.D., and Jessica Leschied, M.D., FRCPC, FAAP.
History
16-year-old boy with chronic right hip and knee pain, which began after a helmet impact during football and persists despite physical therapy
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Question
What incidental diagnosis is uncovered on this patient’s hip MRI?
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Correct answer
Zinner Syndrome
Discussion
Zinner syndrome is a rare congenital anomaly characterized by the classic triad of unilateral renal agenesis or multicystic renal dysplasia, ipsilateral seminal vesicle cyst, and ejaculatory duct obstruction, resulting from maldevelopment of the distal mesonephric (Wolffian) duct between the 4th and 13th weeks of gestation. In pediatric patients, the diagnosis is often made incidentally with patients frequently remaining asymptomatic until sexual maturity. Ultrasound typically serves as the initial diagnostic modality, revealing the renal anomaly. MRI is the gold standard for definitive diagnosis, providing superior soft tissue characterization and localization. The seminal vesicle cysts demonstrate variable signal intensity on MRI depending on protein content, hemorrhage, or infection, with T1 and T2 characteristics ranging from simple fluid to complex cystic lesions. Key imaging features include the lateral location of the seminal vesicle cyst (distinguishing it from midline Müllerian duct cysts or midline prostatic utricle cysts) and ipsilateral renal anomaly. Management in pediatric patients is predominantly conservative with surveillance; surgical excision is reserved for symptomatic cases.
References
- Zinner Syndrome: A Radiological Journey Through a Little Known Condition. Abdominal Radiology. 2024. Julián Gómez E, Barrios-López M, Galante Mulki MJ, et al.
- Zinner Syndrome in Children: Clinical Presentation, Imaging Findings, Diagnosis, and Outcome. Pediatric Nephrology. 2022. Lin CC, Sheu JC, Tsai PS, et al.
- Seminal Vesicle Cysts with Upper Urinary Tract Abnormalities: A Single-Center Case Series of Pediatric Zinner Syndrome. Urology. 2021. Takemura K, Sato A, Morizawa Y, et al.