Urachal Lesions: Unveiling the Role of Imaging in Accurate Diagnosis

Introduction

Urachus is an embryonic remnant structure formed due to the involution of the cloaca and allantois that serves as a communication channel between the developing urinary bladder and the umbilicus via the allantois. Normally, this structure obliterates by mid-gestation and transforms into a fibrous cord known as the median umbilical ligament.[1] However, incomplete involution leads to various congenital urachal anomalies, which can be detected incidentally on imaging or the patient can present with urinary symptoms or nonspecific abdominal symptoms both in the pediatric and adult population predisposing the patient to infections, inflammation, and malignancy, therefore increasing the morbidity.[2]

The incidence of urachal anomalies is 1 in 5,000 and 1 in 150,000 among adults and infants. The prevalence is higher in men than in women.[3] In a recent study among the urachal anomalies, the urachal cysts are the most common type in children, accounting for approximately 69%.[4] Among benign complications, infection is the most common pathology both in children and adults whereas malignancy occurs exclusively in adults.[5]

The objective of this article was to differentiate the various types of urachal lesions with the help of cross-sectional imaging and ultrasound (USG) to strengthen the understanding of various urachal lesions because of their clinical significance.

Ethical Approval

Not applicable (pictorial article).

Patients' Consent

Patients' consent has been obtained for [Figs. 2] to [8].

Publikationsverlauf

Artikel online veröffentlicht:
28. August 2025

• References

• 1 Berrocal T, López-Pereira P, Arjonilla A, Gutiérrez J. Anomalies of the distal ureter, bladder, and urethra in children: embryologic, radiologic, and pathologic features. Radiographics 2002; 22 (05) 1139-1164
• 2 Yu JS, Kim KW, Lee HJ, Lee YJ, Yoon CS, Kim MJ. Urachal remnant diseases: spectrum of CT and US findings. Radiographics 2001; 21 (02) 451-461
• 3 Wright JL, Porter MP, Li CI, Lange PH, Lin DW. Differences in survival among patients with urachal and nonurachal adenocarcinomas of the bladder. Cancer 2006; 107 (04) 721-728
• 4 Yiee JH, Garcia N, Baker LA, Barber R, Snodgrass WT, Wilcox DT. A diagnostic algorithm for urachal anomalies. J Pediatr Urol 2007; 3 (06) 500-504
• 5 Das JP, Vargas HA, Lee A. et al. The urachus revisited: multimodal imaging of benign & malignant urachal pathology. Br J Radiol 2020; 93 (1110) 20190118
• 6 Ueno T, Hashimoto H, Yokoyama H, Ito M, Kouda K, Kanamaru H. Urachal anomalies: ultrasonography and management. J Pediatr Surg 2003; 38 (08) 1203-1207
• 7 Ashley RA, Inman BA, Sebo TJ. et al. Urachal carcinoma: clinicopathologic features and long-term outcomes of an aggressive malignancy. Cancer 2006; 107 (04) 712-720
• 8 Zoica BS, Doros G, Bataneant M. et al. Infected urachal cyst and acute appendicitis in a 1 year and 11 month old girl. Med Ultrason 2009; 11: 79-83
• 9 El Ammari JE, Ahallal Y, El Yazami Adli O, El Fassi MJ, Farih MH. Urachal sinus presenting with abscess formation. ISRN Urol 2011; 2011: 820924
• 10 Ekwueme KC, Parr NJ. Infected urachal cyst in an adult: a case report and review of the literature. Cases J 2009; 2: 6422
• 11 Schnyder P, Candardjis G. Vesicourachal diverticulum: CT diagnosis in two adults. AJR Am J Roentgenol 1981; 137 (05) 1063-1065
• 12 Budd JS. Infected urachal cyst in an adult presenting as an acute abdomen. J R Soc Med 1989; 82: 558-559
• 13 Koster IM, Cleyndert P, Giard RW. Best cases from the AFIP: urachal carcinoma. Radiographics 2009; 29 (03) 939-942
• 14 Mohile SG, Schleicher L, Petrylak DP. Treatment of metastatic urachal carcinoma in an elderly woman. Nat Clin Pract Oncol 2008; 5 (01) 55-58
• 15 Chen D, Li Y, Yu Z. et al. Investigating urachal carcinoma for more than 15 years. Oncol Lett 2014; 8 (05) 2279-2283
• 16 Herr HW, Bochner BH, Sharp D, Dalbagni G, Reuter VE. Urachal carcinoma: contemporary surgical outcomes. J Urol 2007; 178 (01) 74-78 , discussion 78