Urachal remnant diseases: spectrum of CT and US findings

Radical surgery and IVA-chemotherapeutic regimen to treat embryonal rhabdomyosarcoma of the urachus: case report

Although rhabdomyosarcoma is the most frequent soft tissue tumor in children, there are extremely few reports of this tumor arising from the urachus. The authors describe another case in a 6-year-old female associated with constipation and a painless suprapubic mass. The specimen had the pathological criteria used to define urachal sarcoma (cytological, histological, and immunohistochemical findings) and urachal remnants were not observed. After complete resection of the primary tumor the patient was treated with chemotherapy (ifosfamide, vincristine, and dactinomycin) and remains alive at 4 years' follow-up with no signs of recurrence. Nowadays the management of children with urachal rhabdomyosarcoma usually includes surgery and chemotherapy. Multimodal therapy and surgery are constantly evolving and have significantly improved overall survival of these patients especially in R0 resected patients.

A case of spontaneous rupture perforation of leiomyosarcoma in the urachus of a young boy

A case of spontaneous rupture of the urachal leiomyosarcoma in a 12-year-old boy is presented. This is of interest because massive hemoperitoneum due to spontaneous rupture of the urachal leiomyosarcoma is remarkably rare. We diagnosed based on histopathological features. Partial cystectomy and adjuvant chemo-radiation therapy was done with no sign of local recurrence or metastasis until 6 months after the operation.

Laparoscopic Management of Patent Urachus in an Adult Man

A 35-year-old man presented with recurrent urinary discharge from the umbilicus. A diagnosis of persistent patent urachus was established by magnetic resonance imaging. Radical excision of urachal remnant tissue was accomplished by laparoscopic surgery using four ports. Magnetic resonance imaging is diagnostic in urachal remnants. Radical excision of urachal remnants may safely be done by laparoscopic access.

Subumbilical parietal cystic images

We report three cases of women who came to our observation suffering from a feeling of heaviness in the pelvic floor. Ultrasonography showed, in all cases, a cystic formation, medially located under the umbilicus, suggesting the presence of a cyst of the urachus. Computed tomography and magnetic resonance imaging, however, thanks to a more definite topographic evaluation, allowed elimination of this diagnosis in two patients with history of previous abdominal surgery.

Urachal Abnormalities: An Incidental Finding and What It Can Mean for Your Patient

Urachal abnormalities are rare, especially in adults, and are usually incidentally detected with sonography or by computed tomography. When discovered, they may help to explain patient symptoms. The author reports an incidental finding of urachal diverticula in an adult male. In addition, this report reviews different types of urachal abnormalities, etiology, associated pathology, and treatment.

Computed tomographic appearance of urachal carcinoma associated with urachal diverticulum misdiagnosed by cystoscopy

Urachal carcinoma associated with the urachal diverticulum is rare. We present a surgical case of this condition that was initially diagnosed as bladder urothelial carcinoma by cystoscopy, but was then correctly diagnosed by computed tomography (CT). Whereas the CT appearance mimicked that of bladder cancer, accurate localization of the lesion and identification of the median umbilical ligament clarified diagnosis.

Urachal remnant perforation during umbilical vein catheterization in a newborn

Urachal remnants are uncommon congenital anomalies of the bladder that can be injured during attempted catheterization of an umbilical artery or vein. We present the case of a newborn boy who developed urinary ascites after undergoing an attempted umbilical vein catheterization. He subsequently underwent successful surgical repair of a perforated urachal remnant.

Current management of umbilical abnormalities and related anomalies

Prenatally, the umbilicus is of paramount importance, providing the gateway between the mother and the fetus. As the fetus becomes increasingly autonomous at the end of the second month of fetal life, the connections (vitelline, urachal) diminish in significance and involute. Disturbances in this process can result in a wide variety of abnormalities, ranging from relatively minor defects identified at birth (umbilical granulation tissue) to life-threatening complications quiescent until late adulthood (urachal carcinoma). This section will review the 'state of the art' in evaluation and management of these umbilical and related abnormalities.

Pseudomyxoma peritonei due to mucinous cystadenocarcinoma in situ of the urachus presenting as an inguinal hernia

Pseudomyxoma peritonei is generally caused by appendiceal and ovarian tumors. Other primary sites have been rarely reported. We describe herein the second reported case of pseudomyxoma peritonei due to mucinous cystadenocarcinoma of the urachus. A 54-year-old man was admitted with a left inguinal hernia that had developed several months prior to his admission. During herniorrhaphy, we found a large amount of gelatinous mucinous material in the indirect-hernia sac and made a diagnosis of pseudomyxoma peritonei on cytological grounds. At re-operation, the origin of the pseudomyxoma peritonei proved to be a ruptured urachal cyst. The urachal cyst and the dome of the urinary bladder were excised. In addition, we removed as much of the gelatinous material as possible. On histological examination, a unilocular cyst was found to consist of noninvasive mucinous adenocarcinoma. We succeeded in removing the rest of the mucinous material by postoperative intraperitoneal lavage with dextran solution, and have observed no evidence of recurrence for 7 years since the operation.

Abscess formation as a complication of a ruptured urachal cyst

The urachus is a midline tubular structure that extends upward from the dome of the bladder toward the umbilicus. This tubular structure normally involutes before birth, remaining as a fibrous band with no known function. Persistence of all or any portion of the fetal urachus results in several anomalies, the most common of which is the urachal cyst (Yu JS, Kim KW, Lee HJ, Lee YJ, Yoon CS, Kim MJ, Radiographics, 21:451-4611, 2001; Ohgaki M, Higuchi A, Chou H, Takashina K, Kawakami S, Fujita Y, Hagiwara A, Yamagishi H, Surg Today, 33:75-77, 2003). Although most urachal cysts are asymptomatic, there are a few reports about intraperitoneal rupture of infected urachal cysts, all of which caused peritonitis and sepsis (Ohgaki M, Higuchi A, Chou H, Takashina K, Kawakami S, Fujita Y, Hagiwara A, Yamagishi H, Surg Today, 33:75-77, 2003; Kojima Y, Miyake O, Taniwaki H, Morimoto A, Takahashi S, Fujiwara I, Int J Urol, 10:174-176, 2003; Agatstein EH, Stabile BE, Arch Surg, 119:1269-1273, 1984). We report the imaging and operative findings of a patient, presented with a urachal abscess after a spontaneously ruptured urachal cyst.

Urachal anomalies in children: a single center experience

The objective of this study is to define optimal diagnosis and treatment strategies for patients with urachal anomalies in the pediatric age group. The medical records of 21 children who had undergone surgery for urachal anomalies at Severance Hospital, Yonsei University College of Medicine from January 1990 to April 2005 were reviewed. The subjects included 14 males and 7 females (M:F 2:1). The four types of urachal anomalies confirmed were a urachal cyst in 10 patients (47.6%), a patent urachus in 6 (28.6%), a urachal sinus in 4 (19.0%) and a urachal diverticulum in 1 (4.8%) patient. The most common presenting complaint was umbilical discharge (n = 10, 40.0%), followed by abdominal mass (n = 9, 36.0%). Urachal anomalies were diagnosed by ultrasonography in 18 patients, and 7 of them were additionally examined by computed tomography. The remaining patients were diagnosed solely by surgical exploration. Excision was performed in all patients and was supplemented by partial cystectomy in three. Umbilical discharge was the most common clinical manifestation in our patients, suggesting that ultrasonography should be performed in patients with umbilical discharge to differentiate urachal anomalies. We found the most common anomaly to be the urachal cyst, and all patients were successfully treated by surgical excision.

Sonographic Evaluation of the Child with Lower Abdominal or Pelvic Pain

At many centers, CT has become the primary imaging modality for children who have abdominal pain. CT, however, delivers a substantial radiation dose, which is of particular concern in the pediatric patient. In contrast, sonography does not expose the patient to ionizing radiation. Properly performed, sonography is capable of providing useful diagnostic information in the child who has lower abdominal or pelvic pain. In many children and with many disorders, sonography proves to be the only imaging modality that may be required. In this article, the usefulness of sonography in evaluating disorders producing lower abdominal or pelvic pain in a child is reviewed.

Allantoic cyst: a prenatal clue to patent urachus

A patent urachus, which is typically diagnosed as leakage from the umbilicus postnatally, can present as an allantoic cyst in the umbilical cord antenatally. We report a case of a patent urachus with an allantoic cyst diagnosed via fetal MR imaging at 24 weeks' gestation. Early detection allowed for appropriate counseling and prompt corrective surgery after birth.

Sonography in identification of abdominal wall lesions presenting as palpable masses

OBJECTIVE

Abdominal wall lesions often present as palpable masses. The purpose of this presentation is to provide an overview of the sonographic appearances of different abdominal wall lesions.

METHODS

Patients were scanned with high-frequency (5- to 12-MHz) linear transducers. Extended or panoramic views were recorded often to show the lesion in perspective to adjacent structures in the abdominal wall.

RESULTS

The different layers of the abdominal wall could be clearly shown on high-frequency sonography, and the abdominal wall abnormalities were recognized in all the patients.

CONCLUSIONS

Hernias are the most common abdominal wall lesions. Herniated bowel loops have variable appearances depending on their air-fluid content and degree of obstruction. Localized fluid collections in the abdominal wall (seromas, liquefying hematomas, and abscesses) can be well visualized. More infrequently, tumors or vascular lesions can be identified in the abdominal wall.

Pyourachus: study of two cases

The urachus, or median umbilical ligament, is a midline tubular structure that extends upward from the anterior dome of the bladder toward, the umbilicus and represents the vestigial remnant of at least two embryonic structures, the cloaca and the allantois. The tubular urachus normally involutes before birth, remaining as a fibrous band, however its persistence can give rise to various clinical problems, not only in infants and children but also in adults. We report two cases of pyourachus at our institute with a review of the clinical presentation, imaging findings and surgical management. Both our patients were young males, with haematuria being the presenting feature in one case which has not been previously described in literature.

Cholecysto-urachal fistula

The urachus is an embryonic remnant that connects the primitive bladder to the allantois. Multiple urachal anomalies have been described, including the urachal sinus, urachal cyst, patent urachus, and urachal diverticulum. We describe an unusual case in which a patient with urinary tract infection and dysuria was ultimately found to have urinary gallstones from a urachal connection with the gallbladder.

Quiste de uraco infectado en edad infantil

Urachal cysts are congenital anomalies detected predominantly during the childhood. They are often diagnosed when an infection occur mimicking a variety of acute intra-abdominal or pelvic processes. We present a case in a 7-year-old female infant, diagnosed of infected urachal cyst. The embryologic origin of this anomaly, clinical features, diagnosis and treatment are discussed.

Giant cystic abdominal masses in children

In this pictorial essay the common and uncommon causes of large cystic and cyst-like abdominal masses in children are reviewed. We discuss and illustrate the following: mesenchymal hamartoma, choledochal cyst, hydrops of the gallbladder, congenital splenic cyst, pancreatic pseudocyst, pancreatic cystadenoma, hydronephrosis, multicystic dysplastic kidney, multilocular cystic nephroma, adrenal hemorrhage, mesenteric and omental cysts, gastrointestinal duplication cyst, meconium pseudocyst, ovarian cysts and cystic neoplasms, hematocolpos, urachal cysts, appendiceal abscess, abdominal and sacrococcygeal teratoma, and CSF pseudocyst. We also describe imaging features and clues to the diagnosis.

Prevalence and radiologic and histologic appearance of vesicourachal diverticula in dogs without clinical signs of urinary tract disease

OBJECTIVE

To determine prevalence and radiologic and histologic appearance of vesicourachal diverticula in dogs without clinical signs of urinary tract disease.

DESIGN

Original study.

ANIMALS

50 dogs between 4 months and 17 years old representing 22 breeds that had been euthanatized for unrelated reasons; none of the dogs had a history or clinical signs of urinary tract disease.

PROCEDURE

Retrograde positive-contrast radiography was performed, and radiographs were examined for macroscopic diverticula. Necropsy specimens from the urinary bladder vertex were examined by means of light microscopy for diverticula and signs of inflammation.

RESULTS

17 of the 50 (34%) dogs had vesicourachal diverticula, and 1 additional dog had a urachal cyst. Fifteen of the 17 diverticula were macroscopic; surface area of the diverticulum could be measured radiographically in 13 of these dogs and ranged from 1 to 90 mm2. The remaining 2 diverticula were microscopic. Sixteen diverticula were intramural and 1 was extramural. Light microscopic signs of bladder wall inflammation could be detected in 5 dogs, 4 of which had macroscopic diverticula.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggest that a high percentage of dogs without clinical signs of urinary tract disease may have vesicourachal [corrected] diverticula. Further studies are needed to determine the clinical relevance of vesicourethral diverticula in dogs.

Sonography of the thoracic and abdominal walls

Pathologic processes that may involve the thoracic or abdominal wall occasionally raise diagnostic challenges because of the low specificity of physical findings. Congenital and developmental anomalies may mimic soft-tissue or bone tumors; tumors may mimic inflammatory and infectious diseases, and vice versa. Furthermore, these disorders may produce remote manifestations that are frequently misdiagnosed as visceral pain. Many of these parietal processes have typical sonographic appearances that allow definitive diagnosis. This article reviews characteristic sonographic appearances of thoracic and abdominal wall disorders. Familiarity with these sonographic features facilitates accurate diagnosis and optimal patient treatment.

Computed tomographic appearance of urachal adenocarcinomas: review of 25 cases

Twenty-five cases of surgically proven urachal carcinomas were retrospectively reviewed. The radiological archives at the Armed Forces Institute of Pathology were searched for cases of surgically proven urachal carcinomas that had a computed tomographic (CT) scan as a part of their radiologic evaluation. CT images from all cases were evaluated to determine tumor morphology, presence and localization of calcification, extent of bladder invasion and metastases. Tumor size at presentation averaged 6 cm. Twenty-one of 25 (84%) were mixed cystic solid lesions and 4/25 (16%) were completely solid. Calcifications were present in 18/25 (72%), with 11 peripherally located, 3 central only and 4 both. Bladder wall invasion was present in 23/25 (92%), but was seen as an intraluminal mass in only 13/25 (52%). The bulk of the mass was extravesicular in 22/25 (88%). Metastases were present in 12/25 (48%). Our series supports observations from other smaller series that a midline, calcified, supravesicular mass is highly suspicious, if not pathognomonic, for urachal carcinoma.

Pleomorphic sarcoma of the adult urinary bladder: sonographic findings

Sarcomas with muscular differentiation (eg, rhabdomyosarcoma, leiomyosarcoma, pleomorphic sarcoma) are uncommon in the adult urinary bladder. We report the sonographic findings in a case of pleomorphic sarcoma with muscular differentiation arising from the bladder dome that mimicked urachal carcinoma; findings of correlative imaging are also discussed.

CT of Meckel's diverticulitis in 11 patients

OBJECTIVE

This study reviews the CT findings of Meckel's diverticulitis in 11 patients and, to our knowledge, represents the largest series of such cases reported to date.

CONCLUSION

The inflamed Meckel's diverticulum may be visualized on CT in most patients, appearing as a blind-ending pouch of variable size and mural thickness and containing fluid, air, or particulate material with surrounding mesenteric inflammation. The location of the diverticulum may vary from the right lower quadrant to the mid abdomen, with most cases in this series located near midline. Optimal luminal opacification of the ileocecal bowel with oral contrast material facilitated detection of the diverticulum and also proved invaluable in enabling identification of the normal appendix. The diagnosis is most difficult in the setting of secondary intestinal obstruction.

[A case of urachal remnant and review of the literature]

Urachal remnants are not exceptional and are symptomatics if complicated. Ultrasound and CT scan identify most diseases entities originating from urachal remnant. Treatment consists on total exeresis because there is a risk of malignant degeneration. The authors report a case of urachal remnant and analysis the anatomopathologic, diagnosis and therapeutic features of urachal remnants in a review of the literature.

The image of urachus adenocarcinoma on Doppler ultrasonography

Malignant urachal lesions are exceedingly rare and occur predominantly in adult life. In this case report, an adult patient with urachal carcinoma is presented with abdominal plain film, intravenous urography, gray-scale ultrasonography (US), Doppler US, and computed tomography (CT). Doppler US successfully showed the neovascularity with low resistive index value in the urachus tumor. We believe that Doppler US examination is helpful in the differential diagnosis of urachal carcinoma.

Anomalies of the distal ureter, bladder, and urethra in children: embryologic, radiologic, and pathologic features

Congenital anomalies of the lower urinary tract are a significant cause of morbidity in infancy. Radiologic investigation is an important source of clinical information in lower urinary tract disorders but should not inconvenience the patient, expose the patient to unnecessary radiation, or delay surgical correction. In pediatric patients with suspected underlying urologic structural anomalies, screening ultrasonography is commonly the initial diagnostic study. If dilatation of the urinary tract is confirmed, voiding cystourethrography is performed to determine the presence of vesicoureteral reflux (VUR) and other causes of upper tract dilatation. If VUR is confirmed, follow-up with nuclear cystography or echo-enhanced cystosonography may be performed. If VUR is excluded, nuclear diuresis renography is the primary test for differentiating between obstructed and nonobstructed megaureter. Intravenous urography can be used to specifically identify an area of obstruction and to determine the presence of duplex collecting systems and a ureterocele. Computed tomography and magnetic resonance (MR) imaging are unsuitable for general screening but provide superb anatomic detail and added diagnostic specificity. MR imaging is mandatory in the evaluation of associated spinal anomalies. MR urography can demonstrate ectopic extravesical ureteric insertions, thereby providing a global view of the malformation. Familiarity with anomalies of the lower urinary tract is essential for correct diagnosis and appropriate management.