URACHAL MASSES. Dr Saneej
-
Upload
ultrafest -
Category
Health & Medicine
-
view
175 -
download
0
Transcript of URACHAL MASSES. Dr Saneej
![Page 1: URACHAL MASSES. Dr Saneej](https://reader035.fdocuments.in/reader035/viewer/2022062312/55664c53d8b42ab75e8b4a3c/html5/thumbnails/1.jpg)
Dr. K. Saneej DMRD,DNBRadiologist, PVS Hospital, Kozhikode
Kerala
rare urachal masses
![Page 2: URACHAL MASSES. Dr Saneej](https://reader035.fdocuments.in/reader035/viewer/2022062312/55664c53d8b42ab75e8b4a3c/html5/thumbnails/2.jpg)
Apr 12, 2023 ULTRAFEST
53 year old female•Complex cystic mass ant to UB•Iso to hyperechoic solid compnt
Mass projecting into UB lumen
3 months H/o Lower abd painRecurrent UTI, Passing of frothy urinePainless Hematuria
![Page 3: URACHAL MASSES. Dr Saneej](https://reader035.fdocuments.in/reader035/viewer/2022062312/55664c53d8b42ab75e8b4a3c/html5/thumbnails/3.jpg)
Apr 12, 2023 ULTRAFEST
Usg pelvisLesion Anterosuperior to UB
![Page 4: URACHAL MASSES. Dr Saneej](https://reader035.fdocuments.in/reader035/viewer/2022062312/55664c53d8b42ab75e8b4a3c/html5/thumbnails/4.jpg)
Apr 12, 2023 ULTRAFEST
Peripheral enhancement• Air within UB• Polypoidal, irregular
margins• Lobulated contour• Arising from ant wall of
UB• Central nonenhancing
area
• Contact with ant abd wall
• Epicentre may be anterior to UB
![Page 5: URACHAL MASSES. Dr Saneej](https://reader035.fdocuments.in/reader035/viewer/2022062312/55664c53d8b42ab75e8b4a3c/html5/thumbnails/5.jpg)
Apr 12, 2023 ULTRAFEST
diagnosis
• Urachal adenocarcinoma – Mucinous variety with local infiltration
• HPR: Poorly diff mucinous adenoca of signet-ring cell type Consistent with malignant transformation of a urachal cyst
Cystoscopy
![Page 6: URACHAL MASSES. Dr Saneej](https://reader035.fdocuments.in/reader035/viewer/2022062312/55664c53d8b42ab75e8b4a3c/html5/thumbnails/6.jpg)
Apr 12, 2023 ULTRAFEST
• One month old infant , c/o swelling , redness and crying on touching umbilicus
CASE ii
![Page 7: URACHAL MASSES. Dr Saneej](https://reader035.fdocuments.in/reader035/viewer/2022062312/55664c53d8b42ab75e8b4a3c/html5/thumbnails/7.jpg)
Apr 12, 2023 ULTRAFEST
Urinary bladderSagittalThickened cord like structure from dome
Leading to a cystic lesion
![Page 8: URACHAL MASSES. Dr Saneej](https://reader035.fdocuments.in/reader035/viewer/2022062312/55664c53d8b42ab75e8b4a3c/html5/thumbnails/8.jpg)
Apr 12, 2023 ULTRAFEST
Thick walled cystic lesionIn b/w UB dome & umbilicus
A Thickened cord above the cyst connecting to umbilicus
![Page 9: URACHAL MASSES. Dr Saneej](https://reader035.fdocuments.in/reader035/viewer/2022062312/55664c53d8b42ab75e8b4a3c/html5/thumbnails/9.jpg)
Apr 12, 2023 ULTRAFEST
Thick walled cyst in retzius spaceAxial cyst
Axial Cord
![Page 10: URACHAL MASSES. Dr Saneej](https://reader035.fdocuments.in/reader035/viewer/2022062312/55664c53d8b42ab75e8b4a3c/html5/thumbnails/10.jpg)
Apr 12, 2023 ULTRAFEST
urachal cyst with 20 infn
![Page 11: URACHAL MASSES. Dr Saneej](https://reader035.fdocuments.in/reader035/viewer/2022062312/55664c53d8b42ab75e8b4a3c/html5/thumbnails/11.jpg)
Apr 12, 2023 ULTRAFEST
![Page 12: URACHAL MASSES. Dr Saneej](https://reader035.fdocuments.in/reader035/viewer/2022062312/55664c53d8b42ab75e8b4a3c/html5/thumbnails/12.jpg)
Apr 12, 2023 ULTRAFEST
urachus
• Midline remnant of at least 2 embryonic structures– Cloaca & allantois
Continuity of ventral cloaca and allantois in an 8 wk fetus.
Urachal Remnant Diseases: Spectrum of CT & US Findings Jeong-Sik Yu, MD, Ki Whang Kim, March 2001 RadioGraphics, 21,451-461.
![Page 13: URACHAL MASSES. Dr Saneej](https://reader035.fdocuments.in/reader035/viewer/2022062312/55664c53d8b42ab75e8b4a3c/html5/thumbnails/13.jpg)
Apr 12, 2023 ULTRAFEST
patent urachusA. Normal obliteration of the Urachal lumen.B. Urachal cyst.C. Patent urachus.D. Urachal sinus.E. Urachal diverticulum.
(Guray, Sogut, et al. Urachal Cyst. Eastern Journal of Medicine 5 (2) : 76-78, 2000)
![Page 14: URACHAL MASSES. Dr Saneej](https://reader035.fdocuments.in/reader035/viewer/2022062312/55664c53d8b42ab75e8b4a3c/html5/thumbnails/14.jpg)
Apr 12, 2023 ULTRAFEST
late fetal life- urachus
• Deteriorates to a fibrous band• Median umbilical ligament• Extends from ant dome of bladder
toward umbilicus
![Page 15: URACHAL MASSES. Dr Saneej](https://reader035.fdocuments.in/reader035/viewer/2022062312/55664c53d8b42ab75e8b4a3c/html5/thumbnails/15.jpg)
Apr 12, 2023 ULTRAFEST
In our case
• Malignant transformation of a urachal cyst
![Page 16: URACHAL MASSES. Dr Saneej](https://reader035.fdocuments.in/reader035/viewer/2022062312/55664c53d8b42ab75e8b4a3c/html5/thumbnails/16.jpg)
Apr 12, 2023 ULTRAFEST
Retzius space
• Located extraperitoneally
• Bounded by transverse fascia ventrally & parietal peritoneum dorsally.
• Area is called the Retzius space
![Page 17: URACHAL MASSES. Dr Saneej](https://reader035.fdocuments.in/reader035/viewer/2022062312/55664c53d8b42ab75e8b4a3c/html5/thumbnails/17.jpg)
Apr 12, 2023 ULTRAFEST
clinical significance
• Typical extension of urachal ca along Retzius space helps d/d from vesical ca
![Page 18: URACHAL MASSES. Dr Saneej](https://reader035.fdocuments.in/reader035/viewer/2022062312/55664c53d8b42ab75e8b4a3c/html5/thumbnails/18.jpg)
Apr 12, 2023 ULTRAFEST
Histopathology
• Urachus: normally lined by transitional ep
• Urachal tumors = adenoca• Metaplasia of urachal mucosa into
columnar ep g malignant transformation
![Page 19: URACHAL MASSES. Dr Saneej](https://reader035.fdocuments.in/reader035/viewer/2022062312/55664c53d8b42ab75e8b4a3c/html5/thumbnails/19.jpg)
Apr 12, 2023 ULTRAFEST
Thank youDr. K.Saneej. DMRD,DNB(RD)
Radiologist, PVS HospitalKozhikode Kerala