He has been treated in the past for enlarged cysts with a percutaneous drainage of 1.2 L fluid in May 2007, followed by a seminal vesicle cyst laparoscopic decortication in December 2009. He had been stable and followed with MLN8237 in vivo computed tomographic (CT) scans of the pelvis over time. On presentation to the emergency department, his initial evaluation was significant only for discomfort associated with sharp 8/10 lower abdominal and perineal pain. Vital signs were stable and within normal limits, his physical examination was benign and urinalysis, complete blood count, and basic metabolic panel were all within normal limits. This prompted a CT scan of

his pelvis with intravenous contrast, which revealed a recurrent left seminal vesicle cyst as well as the development of a new large extraperitoneal fluid collection measuring 11.6 cm × 5.0 cm, suspicious for a hematoma. This can be visualized in Figure 1,

with an arrow depicting contrast extravasation suggestive of active hemorrhage from a cystic vessel. Despite normal stable vital signs, adequate pain control, and normal laboratory work, he was admitted for observation with serial laboratory draws. By hospital day 2, he was still doing well but his hemoglobin and hematocrit levels decreased steadily. With CT evidence of active bleeding in the setting of persistently decreasing blood counts, interventional radiology department was consulted for definitive management of his hemorrhagic Palbociclib supplier seminal vesicle cyst. The interventional radiologist performed a percutaneous embolization through a left internal iliac angiogram using Gelfoam slurry and 500-700 μm Embospheres. Digital subtraction angiography was performed, which demonstrated ectatic vessels outlining the enlarged left seminal vesicle as demonstrated in Figure 2A. The inferior seminal vesicle artery followed by the left seminal vesicle artery were

isolated with subsequent placement of Gelfoam and Embospheres. Nonvisualization of contributory vessels to the Unoprostone left seminal vesicle was appreciated after Gelfoam embolization and can be seen in Figure 2B, suggesting successful embolization. The patient was kept overnight for observation and reassessment of complete blood counts. By postoperative day 1, he was asymptomatic with increasing hemoglobin and hematocrit values and was discharged in good condition with routine follow-up. The patient at 1-week follow-up described difficulty voiding and defecating, which was attributed to mass effect on the colon and bladder from the hematoma. Despite these symptoms, the patient’s blood counts remained stable. The patient remained stable hematologically without further hemorrhagic events. The patient had follow-up CT scans 1 year and 2 years after the procedure that demonstrated regression in size. In conclusion, seminal vesicle cysts are a very rare phenomenon, and clinically significant hemorrhagic seminal vesicle cysts are even less common.