SONOWORLD : Infected urachal cyst

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Abdomen » General/Other

Infected urachal cyst

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Author(s) :

Taco Geertsma, MD

Presentation 21 year old female patient with pain in the lower abdomen and raised infection parameters

Caption: Transverse image of the lower abdomen in the midline just below the umbilicus

Description: There is a thick walled cystic structure in the midline underneath and between the rectus muscles with inflammatory changes of the surrounding fat

Caption: Longitudinal image of the lower abdomen in the midline just below the umbilicus

Description: There is a thick walled cystic structure in the midline underneath the umbilicus

Caption: Longitudinal image of the lower abdomen in the midline just below the umbilicus

Description: There is a thick walled cystic structure in the midline underneath the umbilicus

Caption: Transverse color doppler image of the lower abdomen in the midline just below the umbilicus

Description: There is increased vascularity indicating inflammatory changes

Differential Diagnosis

Because of the pain in the right lower abdomen and raised infection parameters the most likely diagnosis in a young female patient, is an appendicitis or pelvic inflammatory disease. The classical presentation on ultrasound of an infected urachal cyst is a cyst or a mass located extraperitoneally in the midline just beneath the rectus abdominis muscle and extending from the umbilicus to the dome of the urinary bladder. This makes it possible to differentiate it from an abdominal wall hernia, a rectus hematoma or endometriosis in the abdominal wall.

Final Diagnosis

Infected urachal cyst

Discussion

An urachal cyst is a sinus remaining from the allantois during embryogenesis. It is a cyst which occurs in the remnants between the umbilicus and the bladder. This is a type of cyst occurring in a persistent portion of the urachus, located in the umbilical region. When it becomes infected patients present with abdominal pain, and fever and raised infection parameters. It may rupture, leading to peritonitis, or it may drain through the umbilicus. Urachal cysts are usually silent clinically until infection occurs although sometimes there is some discharge from the umbilicus. A late complication can be the development of an adenocarcinoma.

For more examples urachal cysts see www.ultrasoundcases.info

Case References

Urachal remnant diseases: spectrum of CT and US findings.Yu JS, Kim KW, Lee HJ, Lee YJ, Yoon CS, Kim MJ. Radiographics. 2001 Mar-Apr;21(2):451-61. Review.

Urachal abnormalities: clinical and imaging features.Nimmonrat A, Na-ChiangMai W, Muttarak M.

Singapore Med J. 2008 Nov;49(11):930-5.

Follow Up

The patient was treated with antibiotics followed by surgical excision

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