CT Findings And Differential Diagnosis Of Urachal Abnormalities

Objective:Explore urachal lesions spiral CT characteristic imaging findings and differential diagnosis, improve the understanding of the disease.Materials and methods: Our group collected on October 1, 2006 to December 31, 2014, the second hospital of tianjin medical university urologist admitted during the period of 26 cases of urachal lesions, all cases were confirmed by operation and pathology, and postoperative follow-up. 18 cases of male, female 8 cases, aged 26-84, an average of 45 years old. Main clinical symptoms for lower abdomen stomach at the bag piece, abdominal pain, fever, blood in the urine, and mucus urine, bladder irritation syndrome(urinary frequency, urgency, urine pain). 26 cases were pelvic CT scan, including 7 cases of pelvic CT enhancement scanning. 23 cases data in ADW4.4 workstation in sagittal and coronary reconstruction. All cases data were retrospectively analyzed, based on literature review and summarize the domestic and foreign literature.Results:This group of 26 cases of urachal lesions cases, 6 cases of urachal cyst, urachal cyst associated with chronic inflammation in 1 case; Urachus diverticulum with stones in 1 case; Urachal carcinoma(14 cases, including 13 cases of urachal mucous adenocarcinoma, urachal small cell type endocrine carcinoma in 1 case; Urachal metastatic carcinoma in 1 case; Urachal chronic inflammation(3 cases), of which the urachal expansion with chronic inflammation in 1 case; Urachal abscess in 1 case. All lesions were located near the belly line, umbilical Retzius clearance between the bladder and urachal walk line within the area. Simple urachal cyst on CT performance for bladder front wall cystic low density shadow, shape is round or class round, smooth and thin capsule wall, mild protruding, capsule contents uniform density; Urachal cyst associated with chronic inflammation in 1 case, CT manifestation of cystic wall thickening, edge blur, cystic wall smooth, inside the capsule slightly higher density, enhanced scan thecal sac visible reinforcement, capsule contents is not improved. Urachus diverticulum with stones CT performance for bladder before hanging wall urachal direction into the lumen of the long and narrow area visible and bladder are interlinked, the capsule wall is smooth, can beseen in the lumen of gourd shape high density shadow, mostly in the bladder lumen, small outside the outline to the bladder. 13 cases of urachal mucous adenocarcinoma, CT manifestations of bladder hanging wall before urachal cyst joint irregular solid cystic neoplasm, uneven density, enhanced solid part of the tumor and cystic wall was significantly strengthened, and mucus ingredient of flake reinforced region, including 4 cases with calcification, were patchy and is located at the periphery of tumors, in violation of the bladder wall along the top of bladder wall to outside the cavity, the cavity growth, nearby localized thickening of bladder wall, irregular soft tissue mass within the bladder wall, and can be a kind of round or lobulated, strengthen the test was obvious uneven; Urachal small cell type endocrine carcinoma in 1 case, computed tomography(CT) of the bladder wall before slant on the right side of irregular soft tissue density with uneven density, inside and outside to the bladder. Shift of urachal carcinoma(colonic mucous adenocarcinoma of bladder, urachal transfer) in 1 case, computed tomography(CT) characterized by diffuse non-uniform thickening of bladder wall, a front wall visible form irregular soft tissue density shadow into cavity, around the colon wall thickening and luminal stenosis, urachal go line area, peritoneum, abdominal wall visible diffuse soft tissue density, and is no clear boundary between the colon, bladder, uneven density, fat around interval fuzzy, higher density and multiple nodules. Urachal chronic inflammation CT performance for bladder before hanging wall urachal go line area visible soft tissue density with a strip(vector, coronary) or circular(axis), boundary fuzzy, fuzzy Retzius clearance and increased density, visible around the show in fuzzy shadow or flake, adjacent to the bladder wall thickening; Urachal expansion with chronic inflammation in 1 case, CT also show the urachal walk line area visible thick stripe(vector, coronary) soft tissue density with the top to the navel center before connecting the bladder. Urachal abscess in 1 case, bladder hanging wall line womb before visible soft tissue density with irregular shape, density is uniform, edge blur, involving the peritoneum and the abdominal wall, higher density, fuzzy Retzius clearance.Conclusion:Urachal lesions were located near the belly line, within the Retzius clearance between the navel and bladder, shaft combined with sagittal position observation is better. Urachal lesions and pathological changes of bladder CT aresometimes difficult to identify, the final diagnosis was needed a pathology.