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Joseph Junewick, MD FACR
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Urachal Remnant

Case Detail

Anatomy: Genitourinary
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Developmental or Congenital
Created: over 7 years ago
Updated: over 7 years ago
Tags: PEDS
Modality/Study Types: US
Activities:
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History

2 month old male with omphalitis and occasional drainage from the umbilicus.


Case Images


Diagnosis

Urachal Remnant

Findings

US – Isoechoic cord extending from the apex of the urinary bladder and flaring at the level of the umbilicus. Doppler shows hyperemia at the umbilicus. No associated cyst.

Discussion

The umbilicus contains remnants of the allantois (urachus) and vitelline (omphalomesenteric) duct, both of which may be variably patent or contain cysts. The vitelline duct connects the distal ileum to the the umbilicus and the urachus connects the urinary bladder to the umbilicus.

Meckel diverticulum is the most common vitelline duct abnormality. It is present in about 4% of the population, occuring on the antimesenteric border of the distal ileum. It is usually asymptomatic but can be associated with bleeding (especially if it contains ectopic gastric mucosa), intussusception, or enteroliths.

Urachal remnants are commonly seen on sonography as focal thickening of the anterior dome of the urinary bladder; rarely an isoechoic cord, sinus or a cord with intervening cysts can be seen extending from the dome of the bladder to the umbilicus. Patients may present with umbilical drainage or omphalitis.

Reference

Nagasaki A, Handa N, Kawanami T. Diagnosis of urachal anomalies in infancy and childhood by contrast fistulography, ultrasound and CT. Pediatr Radiology (1991); 21(5):321-323.



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