The primary considerations and image guided diagnosis of an infected urachal cyst in a pediatric patient
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Published on: March 31, 2023
Daniel Novick1, Brett Heller1, Dahua Zhou1
1Nassau University Medical Center, Department of Radiology, 2201 Hempstead Turnpike, East Meadow, NY 11554, USA.
Insights
Urachal cysts are rare, often asymptomatic remnants of the allantois. Infection can cause symptoms mimicking other conditions, delaying diagnosis and requiring surgical treatment.
Area of Science:
- Urology
- Embryology
- Radiology
Background:
- Urachal cysts arise from the embryological remnant of the allantois, connecting the fetal bladder to the umbilicus.
- These cysts are rare, occurring in 1 in 5000 live births but clinically relevant in only 1 in 150,000 individuals.
Observation:
- Urachal cysts are typically asymptomatic until infection occurs.
- Infected cysts can present with diverse symptoms, including umbilical discharge in children and hematuria in adults, often leading to misdiagnosis.
- Imaging modalities like ultrasound and CT are crucial for diagnosis, revealing characteristic findings such as increased echogenicity or thick-walled cystic structures.
Findings:
- Infection is the primary cause of symptomatic urachal cysts.
- Diagnostic delays are common due to the varied and non-specific presentation of infected urachal cysts.
- Imaging findings on ultrasound and CT are key to identifying urachal remnant diseases.
Implications:
- Prompt diagnosis and treatment of infected urachal cysts are essential to prevent complications.
- Surgical drainage and excision of the urachal remnant offer definitive treatment.
- Increased awareness among clinicians can improve diagnostic accuracy for this rare condition.
Abstract:
Urachal cyst is a rare condition that is typically asymptomatic and will often have symptomatology that is misdiagnosed or missed. A urachal cyst occurs in 1 out of 5000 live-births, but is only clinically relevant in 1 out of 150,000 of the population often as an incidental finding. The urachus is the embryological remnant of the allantois, which connects the apex of the bladder to the umbilicus, and usually fully obliterates to become the median umbilical ligament. Urachal defects are uncommon and cysts are usually asymptomatic until infection results. An infected cyst may present mimicking a wide range of intra-abdominal and pelvic disorders, and accurate diagnosis is often delayed. Children may present with umbilical discharge; adults often have hematuria. Computed tomography (CT) and ultrasound are ideally suited for demonstrating urachal remnant diseases; however, infected urachal cysts commonly display increased echogenicity with ultrasoundsography and thick-walled cystic or mixed attenuation with CT. Drainage and excision of the urachal remnant is the definitive treatment.
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