Infected urachal cyst

Case contributed by Dr Mohamed Saber

Presentation

Recurrent urinary tract infection, dysuria, and incontinence

Patient Data

Age: 5 years
Gender: Male
Ultrasound

The ultrasound study shows a cystic lesion contiguous and outpouching from the anterosuperior urinary bladder wall measuring 1 x 1.5 cm. It presents a complex appearance with a thickened wall and internal echoes Mild circumferential mural thickening of the urinary bladder is also noted.

CT

The CT study confirms the presence of this cystic lesion showing thickened wall and internal densities. Mild circumferential mural thickening of the urinary bladder is again noted.

Annotated image

Annotated images highlight the cyst

Case Discussion

Here is a case of a urachal cyst, one of the congenital urachal anomalies, with imaging signs suggestive of infection including wall thickening and turbid fluid content. It is presumed to be the cause of recurrent urinary tract infection in this child. We can also note a mildly thickened urinary bladder wall consistent with cystitis.

The urachal cyst commonly occurs at the mid urachus however sometimes, it is seen contiguous with the urinary bladder wall as in this case. It is an asymptomatic incidental finding until complicated with infection or bleeding.

For an infected urachal cyst, bladder adenocarcinoma should be considered in the differential diagnosis.

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