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Urachal Anomalies
Paula J. Woodward, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Definitions

            • Group of disorders resulting from incomplete involution of allantois
              • Patent urachus
                • Most common type seen in fetus
                • Open channel from dome of bladder to umbilical cord insertion
                  • Often associated with allantoic cord cyst
              • Urachal cyst
                • Persistence of intermediary segment of urachus forming cyst between bladder and umbilical cord insertion
                  • Fibrous attachments to bladder and umbilicus
              • Urachal diverticulum
                • Persistence of deep segment of urachus creating diverticulum off anterior-superior bladder wall
                • Often incidental finding later in childhood or adulthood
              • Urachal sinus
                • Persistence of superficial segment of urachus opening onto skin surface
                • Usually diagnosed on postnatal physical exam

          IMAGING

          • General Features

            • Ultrasonographic Findings

              • Imaging Recommendations

                • MR Findings

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • General Features

                      • Gross Pathologic & Surgical Features

                        CLINICAL ISSUES

                        • Presentation

                          • Demographics

                            • Natural History & Prognosis

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Consider

                                  • Image Interpretation Pearls

                                    Selected References

                                    1. Riddell JV et al: Prenatal vesico-allantoic cyst outcome - a spectrum from patent urachus to bladder exstrophy. Prenat Diagn. 35(13):1342-6, 2015
                                    2. Trong Thach T et al: Case Report: Pre- and postnatal management of an allantoic cyst with patent urachus and single umbilical artery. F1000Res. 4:124, 2015
                                    3. Umeda S et al: Prenatal and postnatal clinical course of an urachus identified as an allantoic cyst in the umbilical cord. Eur J Pediatr Surg. 26(2):200-2, 2015
                                    4. Naiditch JA et al: Current diagnosis and management of urachal remnants. J Pediatr Surg. 48(10):2148-52, 2013
                                    5. Rasteiro C et al: Bladder emptying into an umbilical cord cyst: prenatal sonographic sign of allantoic cyst with patent urachus. Ultrasound Obstet Gynecol. 42(2):239-40, 2013
                                    6. Tsai MS et al: Images in clinical medicine. Patent urachus. N Engl J Med. 365(14):1328, 2011
                                    7. Sepulveda W et al: Megacystis associated with an umbilical cord cyst: a sonographic feature of a patent urachus in the first trimester. J Ultrasound Med. 29(2):295-300, 2010
                                    8. Pal K et al: Allantoic cyst and patent urachus. Indian J Pediatr. 76(2):221-3, 2009
                                    9. Weichert J et al: Prenatal management of an allantoic cyst with patent urachus. Arch Gynecol Obstet. 280(2):321-3, 2009
                                    10. Fuchs F et al: Prenatal diagnosis of a patent urachus cyst with the use of 2D, 3D, 4D ultrasound and fetal magnetic resonance imaging. Fetal Diagn Ther. 24(4):444-7, 2008
                                    11. Sulak O et al: Anatomical development of the normal urachus during the fetal period. Saudi Med J. 29(1):30-5, 2008
                                    12. Matsui F et al: Prenatally diagnosed patent urachus with bladder prolapse. J Pediatr Surg. 42(12):e7-10, 2007
                                    13. Bunch PT et al: Allantoic cyst: a prenatal clue to patent urachus. Pediatr Radiol. 36(10):1090-5, 2006
                                    14. Lugo B et al: Bladder prolapse through a patent urachus: fetal and neonatal features. J Pediatr Surg. 41(5):e5-7, 2006
                                    15. Yu JS et al: Urachal remnant diseases: spectrum of CT and US findings. Radiographics. 21(2):451-61, 2001
                                    16. Awwad J et al: Sonographic diagnosis of a urachal cyst in utero. Acta Obstet Gynecol Scand. 73(2):156-7, 1994
                                    17. Hill LM et al: The sonographic diagnosis of urachal cysts in utero. J Clin Ultrasound. 18(5):434-7, 1990
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Imaging

                                        • Top Differential Diagnoses

                                          • Clinical Issues

                                            TERMINOLOGY

                                            • Definitions

                                              • Group of disorders resulting from incomplete involution of allantois
                                                • Patent urachus
                                                  • Most common type seen in fetus
                                                  • Open channel from dome of bladder to umbilical cord insertion
                                                    • Often associated with allantoic cord cyst
                                                • Urachal cyst
                                                  • Persistence of intermediary segment of urachus forming cyst between bladder and umbilical cord insertion
                                                    • Fibrous attachments to bladder and umbilicus
                                                • Urachal diverticulum
                                                  • Persistence of deep segment of urachus creating diverticulum off anterior-superior bladder wall
                                                  • Often incidental finding later in childhood or adulthood
                                                • Urachal sinus
                                                  • Persistence of superficial segment of urachus opening onto skin surface
                                                  • Usually diagnosed on postnatal physical exam

                                            IMAGING

                                            • General Features

                                              • Ultrasonographic Findings

                                                • Imaging Recommendations

                                                  • MR Findings

                                                    DIFFERENTIAL DIAGNOSIS

                                                      PATHOLOGY

                                                      • General Features

                                                        • Gross Pathologic & Surgical Features

                                                          CLINICAL ISSUES

                                                          • Presentation

                                                            • Demographics

                                                              • Natural History & Prognosis

                                                                • Treatment

                                                                  DIAGNOSTIC CHECKLIST

                                                                  • Consider

                                                                    • Image Interpretation Pearls

                                                                      Selected References

                                                                      1. Riddell JV et al: Prenatal vesico-allantoic cyst outcome - a spectrum from patent urachus to bladder exstrophy. Prenat Diagn. 35(13):1342-6, 2015
                                                                      2. Trong Thach T et al: Case Report: Pre- and postnatal management of an allantoic cyst with patent urachus and single umbilical artery. F1000Res. 4:124, 2015
                                                                      3. Umeda S et al: Prenatal and postnatal clinical course of an urachus identified as an allantoic cyst in the umbilical cord. Eur J Pediatr Surg. 26(2):200-2, 2015
                                                                      4. Naiditch JA et al: Current diagnosis and management of urachal remnants. J Pediatr Surg. 48(10):2148-52, 2013
                                                                      5. Rasteiro C et al: Bladder emptying into an umbilical cord cyst: prenatal sonographic sign of allantoic cyst with patent urachus. Ultrasound Obstet Gynecol. 42(2):239-40, 2013
                                                                      6. Tsai MS et al: Images in clinical medicine. Patent urachus. N Engl J Med. 365(14):1328, 2011
                                                                      7. Sepulveda W et al: Megacystis associated with an umbilical cord cyst: a sonographic feature of a patent urachus in the first trimester. J Ultrasound Med. 29(2):295-300, 2010
                                                                      8. Pal K et al: Allantoic cyst and patent urachus. Indian J Pediatr. 76(2):221-3, 2009
                                                                      9. Weichert J et al: Prenatal management of an allantoic cyst with patent urachus. Arch Gynecol Obstet. 280(2):321-3, 2009
                                                                      10. Fuchs F et al: Prenatal diagnosis of a patent urachus cyst with the use of 2D, 3D, 4D ultrasound and fetal magnetic resonance imaging. Fetal Diagn Ther. 24(4):444-7, 2008
                                                                      11. Sulak O et al: Anatomical development of the normal urachus during the fetal period. Saudi Med J. 29(1):30-5, 2008
                                                                      12. Matsui F et al: Prenatally diagnosed patent urachus with bladder prolapse. J Pediatr Surg. 42(12):e7-10, 2007
                                                                      13. Bunch PT et al: Allantoic cyst: a prenatal clue to patent urachus. Pediatr Radiol. 36(10):1090-5, 2006
                                                                      14. Lugo B et al: Bladder prolapse through a patent urachus: fetal and neonatal features. J Pediatr Surg. 41(5):e5-7, 2006
                                                                      15. Yu JS et al: Urachal remnant diseases: spectrum of CT and US findings. Radiographics. 21(2):451-61, 2001
                                                                      16. Awwad J et al: Sonographic diagnosis of a urachal cyst in utero. Acta Obstet Gynecol Scand. 73(2):156-7, 1994
                                                                      17. Hill LM et al: The sonographic diagnosis of urachal cysts in utero. J Clin Ultrasound. 18(5):434-7, 1990