Infected vesicourachal diverticulum

Case contributed by Dr Varun Babu

Presentation

Recurrent UTI for evaluation. Known patient of endometriosis; current presenting symptom being suprapubic tenderness and lower abdominal pain.

Patient Data

Age: 40 years
Gender: Female

Transabdominal pelvic ultrasound

Ultrasound

Immediately on placing the probe in the midline at the level of umbilicus and tracing down, a well defined circular lumen tubular tract was identified tracking midline caudally towards the superior surface and dome of the urinary bladder. 

MRI pelvis

MRI

T2 weighted images identified a midline thick walled irregularly patent urachus suggestive of underlying inflammation. 

Case Discussion

This patient unfortunately was constantly being evaluated by a gynecologist who only ventured to doing transvaginal scans. Once again highlights the importance of approaching the pelvic ultrasound trans abdominally for a holistic perspective prior to going trans vaginal. 

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