Best Examination Tips: Medcase, Interesting Medical Cases and Pictures

  • Sunday, July 7th, 2013

Case 26/Picture 28 (01.08.2015.) Could you identify the condition?

Uracus

Answer

It appears as a circular pink-red mass within an inflamed skin fold on the abdomen (umbilicus) of a small child from the Indian sub-continent apparently lying on the bed . Use of the red thread around the abdomen is a prevalent culture in the Indian sub-continent to protect children from illness etc. The differential diagnosis of an umbilical mass includes granuloma, polyp, hernia, dermoid cyst, hemangioma, inclusion cyst, omphalomesenteric remnant, urachal remnant etc. Sister Mary Joseph’s Nodule is extremely unlikely in a child. This is  picture of Urachal remnant. Urachal remnants – The developing bladder remains connected to the allantois through the urachus, and remnants of this connection include a patent urachus, urachal sinus, and urachal cyst; umbilical polyps can also be observed in association with a urachal remnant. The presentation of urachal remnants also varies. Clear drainage from the umbilicus is characteristic of a urachal fistula. Drainage of urine from the umbilicus may suggest bladder outlet obstruction and warrants further investigation. A urachal cyst is usually discovered as a painful mass between the umbilicus and suprapubic area when it becomes infected. Pain and retraction of the umbilicus during urination may suggest a urachal anomaly. A urachal sinus manifests with drainage that can be clear or purulent and occurs through the umbilicus or midline skin below the umbilicus.

Reference

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