Images in Emergency Medicine
Article Outline
[Ann Emerg Med. 2007;50:199.]
A 3-year-old black girl presented with a 1-day history of a painful midline suprapubic mass (Figure 1), dysuria, and fever to 104°F (40°C). The mass was fluctuant, mildly erythematous, and tender to palpation. The initial ultrasonograph was nondiagnostic, and a subsequent computed tomography (CT) scan of the abdomen was performed (Figure 2).
Figure 1.
Physical appearance of mass.
Figure 2.
Representative axial CT section. Used with permission of Derek R Linklater, MD, Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine/Texas Children’s Hospital, Houston, TX.
Diagnosis
Infected urachal cyst
The patient was taken to the operating room, where 40 mL of purulent material was removed and a Penrose drain placed; cultures revealed infection with Proteus mirabilis susceptible to ampicillin. The patient was treated with antibiotics and discharged after 5 days with the drain in place. The patient was doing well at 3-week follow-up, and the drain was removed. Surgical excision of the cyst is planned.
Urachal cysts result from a persistence of the embryologic urachus, a structure that connects the urinary bladder with the allantois (the precursor of a mature umbilical cord). Urachal cysts are the most common type of the 4 types of urachal remnants and are present in 1 in 5,000 births.1 Diagnosis is often delayed until infection develops; the most common organism is Staphylococcus aureus, but many others have been reported.2 Either CT or ultrasonography may be used to confirm the diagnosis.3 The treatment of infected cysts is primarily surgical and should proceed in stages: an initial drainage procedure combined with antibiotic therapy, followed by a complete excision of the cyst at a later date.4, 5
References
- . Acute abdominal pain secondary to a urachal cyst abscess. J Am Osteopath Assoc. 1998;98:51–52
- . Acute presentation of infected urachal cysts: case report and review of diagnosis and therapeutic interventions. Pediatr Emerg Care. 2004;20:108–111
- Urachal remnant diseases: spectrum of CT and US findings. Radiographics. 2001;21:451–461
- . Surgical implications of urachal remnants: presentation and management. J Pediatr Surg. 2003;38:798–803
- . Treatment of infected urachal cysts. Yonsei Med J. 2006;47:723–727
For the diagnosis and teaching points, see page 210.To view the entire collection of Images in Emergency Medicine, visit www.annemergmed.com
PII: S0196-0644(07)00071-6
doi:10.1016/j.annemergmed.2007.01.011
© 2007 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
