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Rare Case of Hemorrhagic Cyst at Vas Deferens Ampulla: Diagnosis through Ultrasound and MRI

This report presents a unique case of a hemorrhagic cyst located in the vas deferens ampulla of a 29-year-old male, following pelvic trauma. Imaging studies, including pelvic ultrasound and MRI, revealed a well-defined cystic mass with hemorrhagic content. The case highlights the importance of echography and MRI in diagnosing urogenital cysts, particularly in trauma cases. Furthermore, it discusses associated conditions such as renal agenesis and emphasizes the significance of imaging in evaluating complex presentations in the urogenital tract.

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Rare Case of Hemorrhagic Cyst at Vas Deferens Ampulla: Diagnosis through Ultrasound and MRI

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  1. URINARY: UR16

  2. 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

  3. 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.

  4. 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.

  5. 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.

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

  7. Results and discussion: • 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.

  8. 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.

  9. 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.

  10. 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.

  11. Results and discussion: • 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.

  12. 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.

  13. 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.

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