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Seminal Vesicle Hydatid Cysts: CT Features in Two Patients

Tzaneion Hospital, Piraeus, Greece
Sismanoglio Hospital Attica, Greece

Involvement of seminal vesicles by hydatid disease is rare. Hydatid disease may go undetected for long periods because it has nonspecific symptoms. We report two cases of seminal vesicle hydatid disease that presented with vague symptoms but that showed typical imaging features on CT.

A 68-year-old man was referred to our hospital for evaluation of renal colic, which he had for the last 6 months. Chest radiography findings were normal. A sonogram showed no abnormality, but further evaluation with CT revealed an enlarged right seminal vesicle containing typical daughter cysts (Fig. 3). The cyst was excised surgically, and the hydatid disease diagnosis was confirmed.

View larger version (128K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3. —68-year-old man with hydatid disease. Axial CT image shows enlarged right seminal vesicle with smooth borders containing daughter cysts.

A 30-year-old male farmer raising sheep on his land was admitted to our hospital with vague abdominal pain, mild dysuria, and hemospermia of 5-months' duration. He reported no previous surgery in the abdomen, but he said his mother had liver echinococcosis 7 years ago. Chest radiography and blood test results were normal. Physical examination findings were unremarkable. A CT scan of the abdomen was obtained. Two large cystic lesions containing daughter cysts were detected in the pelvic region (Fig. 4). Another hydatid cyst was found in the liver. The patient underwent surgery, and the diagnosis of Echinococcus granulosus disease was confirmed.

View larger version (168K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4. —30-year-old male farmer with Echinococcus granulosus disease. Axial CT image shows bilateral lesions with daughter cysts situated behind urinary bladder. Medially conjoined cysts show bow tie configuration.

Hydatid disease of the retroperitoneum is a rare condition. Kidneys are affected in 2–4% of patients, and seminal vesicles are not usually involved [1, 2]. In most reported cases, peritoneal cysts are considered to be secondary developments from liver cyst rupture and consequent spillage in the peritoneal space. Isolated retroperitoneal cysts are rare, and a pathogenic origin via hematogenous or lymphatic routes has been proposed for cases in which primary visceral lesions are absent. Presenting symptoms may vary and are usually nonspecific [1, 3, 4].

Cysts are initially unilocular, and over time, they may grow into multivesicular structures and form daughter cysts. Their walls are thin and smooth-bordered, and their content shows water attenuation [1, 2]. Their shape deforms the seminal vesicle contour as they enlarge; this feature has not previously been reported because hydatid seminal vesicles are so rare. CT is considered the method of choice for characterizing cysts in patients with inconclusive sonographic findings, and it can also reveal other possible sites of involvement.

Surgical treatment is considered successful when the cyst is completely removed without contaminating other structures and prophylactic therapy has begun [3].

References

1. Angulo JC, Escribano J, Diego A, Sanchez-Chapado. Isolated retrovesical and extrarenal retroperitoneal hydatidosis: clinical study of 10 cases and literature review. J Urol1998; 159:76 –82[Medline]
2. Sagglam M, Tasar M, Bulakbasi N, Tayfun C, Somuncu I. TRUS, CT and MRI findings of hydatid disease of seminal vesicles. Eur Radiol 1998;8:933 –935[Medline]
3. Emir L, Karabulut A, Balci U, Germiyanoglu C, Erol D. An unusual case of urinary retention: a primary retrovesical echinococcal cyst. Urology 2000;56:856 –858
4. Whyman MR, Morris DL. Retrovesical hydatid causing haemospermia. Br J Urol 1991;68:100 –101[Medline]

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This Article Figures Only Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Passomenos, D. Articles by Sklavos, H. Search for Related Content PubMed PubMed Citation Articles by Passomenos, D. Articles by Sklavos, H. Social Bookmarking                      What's this?