Patent urachus (ultrasound)
6 week old boy with umbilical granuloma s/p silver nitrate treatment presents with continuous ongoing discharge from umbilicus.
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Anechoic tubular structure measuring 3mm in width connects the anterior superior aspect of the urinary bladder to the anterior abdominal wall on longitudinal view. On transverse view, defect is visualized extending through the umbilicus.
The urachus is the intra-abdominal portion of the allantois. If there is the failure of the allantois to involute, urachal anomalies can occur. A complete failure of involution is termed "patent urachus", which is demonstrated in our case. Partial failure of closure can result in anomalies such as a urachal cyst, diverticulum, or sinus. Patent urachus is the most common of these anomalies. Patent urachus typically presents as persistent drainage or inflammation at the umbilicus in the newborn period. An anterior, midline cystic structure extending from the bladder dome to the anterior abdominal wall is diagnostic. Recommended treatment is surgical excision, which has an excellent prognosis.
Case submitted by Dr J. Behringer and Dr. L. Griffin.
- Statdx - Urachal Anomalies by Amir A. Borhani, MD; Michael P. Federle, MD, FACR