Urachal anomalies

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The urachus connects the dome of the bladder to the umbilicus duct during fetal life. The urachus is located behind the abdominal wall and anterior to the peritoneum in the space of Retzius. Before birth, the urachus is obliterated and becomes a vestigial structure known as the medial umbilical ligament. In the absence of complete obliteration, the urachus persists as either a patent urachus, urachal cyst, urachal sinus, or urachal diverticulum.

Classification

Patent urachus

• Patent urachus represents the failure of the entire course of the urachus to close resulting in an open channel between the bladder and the umbilicus.
• A patent urachus is usually diagnosed in the neonate when urine is noted leaking from the umbilicus.

Urachal cyst

• Urachal cyst forms when both the umbilical and vesical ends of the urachal lumen close while an intervening portion remains patent and fluid filled.
• Urachal cysts usually remain obscure until complicated by infection or bleeding.

Urachal sinus

• Urachal sinus is a noncommunicating dilatation of the urachus at the umbilical end.

Urachal diverticulum

• Deformity that communicates with the anterosuperior aspect of the bladder as a result of failure of the urachus to close at the bladder.
• A urachal diverticulum frequently coexists with congenital obstruction of the lower urinary tract.

Diagnosis

Patent urachus

• Demonstrated by retrograde injection of contrast material into the orifice of the channel at the umbilical end or during VCUG in the lateral projection.
• Patent urachus manifests at longitudinal US as a tubular connection between the anterosuperior aspect of the bladder and the umbilicus.
• Occasionally, patency of the urachus can be demonstrated at CT.

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Urachal cyst

• At radiology, an uncomplicated urachal cyst appears as a collection of simple fluid localized in the midline of the anterior abdominal wall, between the umbilicus and the pubis and often contiguous with the bladder dome.
• Differential diagnosis includes bladder diverticulum, vitelline cyst, mesenteric cyst, Meckel diverticulum, and umbilical hernia].

Urachal sinus

• An umbilical-urachal sinus manifests at US as a thickened tubular structure along the midline below the umbilicus.

Urachal diverticulum

• This anomaly is identified as a urine-filled anterosuperior extension from the bladder dome at VCUG, US, CT, or MR imaging.