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Imaging of the Urachus.

Maria Zulfiqar1, Parker J Brown1, Komal Chughtai1

  • 1From the Department of Radiology, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ 85259 (M.Z., P.J.B., N.T., M.Y., D.V.T., A.K.); Department of Radiology, Weill Cornell Medicine, New York, NY (K.C.); Department of Pathology (P.N.) and Mallinckrodt Institute of Radiology (C.L.S.), Washington University School of Medicine in St Louis, St Louis, Mo; and Department of Radiology, Phoenix Children's Hospital (A.A., D.V.T.) and University of Arizona (A.A.), Phoenix, Ariz.

Radiographics : a Review Publication of the Radiological Society of North America, Inc
|April 10, 2025
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Summary
This summary is machine-generated.

The urachus, a remnant connecting the bladder to the umbilicus, can develop various congenital anomalies and non-neoplastic or neoplastic diseases. Understanding urachal embryology aids in diagnosing these abnormalities via imaging.

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Area of Science:

  • Embryology
  • Radiology
  • Pathology

Background:

  • The urachus is a remnant of the allantois and cloaca, connecting the fetal urinary bladder to the anterior abdominal wall.
  • Though vestigial, the urachus can be affected by congenital anomalies, inflammatory conditions, and neoplasms.

Purpose of the Study:

  • To explore the embryologic origins and normal anatomy of the urachus.
  • To discuss urachal pathologies and their imaging manifestations across various modalities.
  • To enhance radiologists' diagnostic proficiency in urachal abnormalities.

Main Methods:

  • Review of embryologic development and normal urachal anatomy.
  • Case-based discussion of urachal pathologies using ultrasound (US), CT, and MRI.
  • Analysis of congenital anomalies, inflammatory masses, and neoplastic conditions.

Main Results:

  • Urachal anomalies range from focal patency (cyst, diverticulum, sinus) to complete patency (patent urachus).
  • Non-neoplastic conditions include inflammatory masses and endometriosis; neoplastic entities include adenocarcinoma (most common malignancy), mucinous cystadenoma, urothelial carcinoma, and metastasis.
  • Mimics of urachal pathology include bladder malignancy and dropped appendicoliths/gallstones.

Conclusions:

  • Understanding urachal embryogenesis is key to interpreting imaging findings of urachal abnormalities.
  • Accurate diagnosis of urachal conditions, including mimics, is crucial for effective patient management.
  • This review aims to improve radiologists' recognition and interpretation of urachal abnormalities.