Ultrasound findings of urachal anomalies. A series of interesting cases

Abstract

Aims: This study’s aim is to present the specific ultrasonography (US) findings of a series of urachus anomalies. Material and methods: Seven patients with suspected urachal anomalies underwent US scanning initially prior to the surgery and the features of images were reviewed respectively. The clinical data and pathologic results were collected also. Results: US successfully diagnosed urachal anomalies in 5 patients (5/7, 71.4%) and failed to diagnose in 2 patients (2/7, 28.6%). Patent urachus showed a tubule between the umbilicus and bladder; urachal sinus was a blind focal dilatation at the umbilical end, while vesicourachal diverticulum was an outpouching at the vesical end and urachal cyst was identified as an anechoic structure along the urachus. Non-enhancement in the base and centre was the distinct features of urachus carcinoma by contrastenhanced ultrasonography (CEUS). Using a high frequency probe and CEUS the diagnostic ability of US may be improved. Conclusion: US showed good diagnostic ability in urachal anomalies and combined with CEUS could improve the differential diagnosis.

Evaluation and management of urachal remnants in children

“…If performed with a full bladder, patent urachus and vesicoureteral diverticulum can also be easily identified. 5 The treatment approach for urachal remnants depends on the type of remnant and the patient's symptoms. Small cysts can be observed conservatively.…”

“…5 Urachal anomalies can be diagnosed by imaging methods such as computed tomography and magnetic resonance imaging but the most commonly used imaging method is ultrasonography. 5 Symptomatic urachal remnants should be removed by laparotomy. Previously, urachal remnants were removed surgically due to the risk of infection and the development of malignancy at later ages.…”

Diagnostic accuracy of abdominal ultrasound to detect pathology that needs surgical exploration in children with umbilical discharge

“…The question is whether the cyst is caused by a patent urachus and this poses a significant radiological challenge. The majority of the studies investigating diagnostic accuracy only report the true positive rate in very small patient groups, with numbers ranging from 25 to > 90% [5][6][7][8][9][10]. Only the research group of Widni et al reports sensitivity, specificity, PPV and NPV with the golden standard being the intraoperative findings and histopathologic results.…”

“…Moreover, in children an operation is only performed in case of sufficient suspicion. Some authors would advocate a CT-scan, MRI-scan or voiding cystourethrogram besides or instead of the ultrasound [7,8]. Since there are no clinical consequences involved and it does bring additional ionizing radiation, costs and waiting time, these diagnostics are not embedded in our clinical practice and are of no additional value in our opinion.…”

“…However, disadvantages of the ultrasound are that it is operator dependent and the available literature often only reports the percentage of patients in whom the ultrasound was diagnostic (referred to as 'diagnostic rate') without showing other values of diagnostic accuracy and the golden standard they applied [5][6][7][8][9][10]. Moreover, the majority of these studies have analyzed only a small number of patients (average number of 30 patients).…”