Imaging of the Urachus from congenital anomalies to infection and neoplasm: A Pictorial Review

Congress:

ECR 2019

Poster Number:

C-1627

Type:

Educational Exhibit

Keywords:

Abdomen, Urinary Tract / Bladder, Ultrasound, CT, MR, Biopsy, Surgery, Cancer, Infection, Congenital

Authors:

H. GUERROUM, M. KASSIMI, J. HABI, A. Rami, N. Moussali, M. Mahi, N. Chikhaoui; Casablanca/MA

DOI:

10.26044/ecr2019/C-1627

DOI-Link:

https://dx.doi.org/10.26044/ecr2019/C-1627

Fig. 1: Illustration of a 4th-week embryo shows the cloaca and the extra embryonic...

Fig. 2: (a) Illustration shows the anatomic location of the urachus(arrows). B =...

Fig. 3: Patent urachus in a 33-year-old woman with small purulent discharge through the...

Fig. 4: Patent urachus. Voiding cystourethrogram image of a patent urachus in a newborn...

Fig. 5: Sagittal T2-weighted MR images demonstrate a patent urachus in a 42-year-old...

Learning objectives

Review the embryologic development, anatomy, and imaging appearance of the urachus. Describe and illustrate congenital urachal anomalies, infection and neoplasm.

Background

The urachus is an intra-abdominal fibrous remnant of the cloaca and the allantois. During normal gestational development, the urachus involutes and its lumen is obliterated, becoming the median umbilical ligament. The non-involution of the allantois can lead to urachal anomalies in later life. Urachal anomalies are rare, with higher prevalence in men than women. EMBRYOLOGY (fig.1) The urachus is a vestigial structure remnant of two embryologic structures: the cloaca and the allantois. The ventral aspect of the cloaca elongates and forms four segments between the...

Findings and procedure details

Urachal anomalies represent uncommon and often underdiagnosed entities that may be found incidentally at imaging or manifest clinically with the development of mostly nonspecific abdominal or urinary symptoms. This pictorial review describes and illustrates imaging features of congenital urachal anomalies such as, patent urachus or urachal fistula, urachal cyst, umbilical-urachal sinus, and vesic-ourachal diverticulum, besides infection and urachal neoplasm. Imaging evaluation of urachal remnant anomalies, and complications includes US, CT, MR imaging, cystography, sinography, and cystoscopy. US is usually the first imaging tool to be...

Conclusion

Urachal remnants pathologies are rare, their clinical diagnosis is often delayed because of nonspecific symptoms. US is usually the modality of choice for initial assessment, CT and MR imaging allows further characterization and evaluation of complications. Anomalies that extend to the bladder require excision of the remnant along with placement of a bladder cuff to prevent long-term complications.

Personal information

References

1.Upadhyay V1,Kukkady 2003 A Urachal remnants: an enigma. Eur J Pediatr Surg.2003 Dec;13(6):372-6. 2.Carolina Parada Villavicencio,Sharon Z. Adam,Paul Nikolaidis,Vahid Yaghmai,Frank H. Miller2016 Imaging of the Urachus: Anomalies, Complications, and Mimics Radiographics. 3. Bauer S, Retik A, Urachal anomalies and related umbilical disorders. Urol Clin N Amer 1978; 5: 195-211 4.Rita Espírito Santo,1 Margarida Alcafache,2 Sofia Rodrigues Almeida,3 and Ana Tavares Abnormal appearance of the umbilicus: an indicator of urachal anomalies 2016 5.Yu JS,Kim KW,Lee HJ,Lee YJ,Yoon CS,Kim MJ.Urachal remnant diseases: spectrum of CT and US...