Imaging in Zinner Syndrome, A Case Series: The Wolf in Sheep’s Clothing

Zinner syndrome is a rare congenital malformation of the Wolffian duct with seminal vesicle cyst, ipsilateral renal agenesis and ejaculatory duct obstruction, seen in less than 0.002 % of the male population. An increased awareness among clinicians, urologists, and radiologists is essential, as early diagnosis and management can impact fertility outcomes. This review aims to explain and illustrate Zinner syndrome through imaging case studies. Emphasis is made on considering Zinner syndrome in the differential diagnosis of young males with pelvic pain and renal agenesis, highlighting the importance of radiological evaluation for the management of this uncommon yet clinically significant condition. •The classic triad of Zinner's syndrome consists of renal agenesis, seminal vesicle cysts, and ejaculatory duct obstruction.•Transabdominal ultrasound, TRUS, and MRI are essential modalities to reach an accurate diagnosis.•Symptomatic patients benefit from surgical intervention, with recent advancements in laparoscopic and robotic-assisted techniques providing optimism for better outcomes.•Detailed and timely imaging, clinical expertise and early intervention is crucial to diagnose and manage such unique conditions.