Images in Paediatrics
A neonate with cystic umbilical cord and wet umbilicus
Un neonato con cordón umbilical quístico y ombligo húmedo
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El fistulograma confirmó un uraco permeable (C, flecha) sin alteraciones uretrales (C, punta de flecha). 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Extensive anterior spinal cord hyperintensity from the cervical segment to the conus medullaris (arrows in <span class="elsevierStyleBold">A</span>) in the T2-weighted image. The post-contrast sagittal T1-weighted image showed enhancement of the ventral roots of the cauda equina (arrows in <span class="elsevierStyleBold">C</span>) and absence of enhancement in most of the spinal cord (<span class="elsevierStyleBold">B</span>).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ana Isabel Almeida, Luísa Sampaio, Cláudia Melo, Raquel Sousa" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Ana Isabel" "apellidos" => "Almeida" ] 1 => array:2 [ "nombre" => "Luísa" "apellidos" => "Sampaio" ] 2 => array:2 [ "nombre" => "Cláudia" "apellidos" => "Melo" ] 3 => array:2 [ "nombre" => "Raquel" "apellidos" => "Sousa" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1695403323000176" "doi" => "10.1016/j.anpedi.2023.01.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403323000176?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287923001436?idApp=UINPBA00005H" "url" => "/23412879/0000009900000003/v1_202309061009/S2341287923001436/v1_202309061009/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2341287923001916" "issn" => "23412879" "doi" => "10.1016/j.anpede.2023.08.009" "estado" => "S300" "fechaPublicacion" => "2023-09-01" "aid" => "3450" "copyright" => "Asociación Española de Pediatría" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "An Pediatr (Barc). 2023;99:205-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Cutaneous and hepatic infantile haemangiomas as a clinical manifestation of Beckwith Wiedemann syndrome" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "205" "paginaFinal" => "207" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hemangiomas infantiles cutáneos y hepáticos como manifestación clínica de síndrome de Beckwith-Wiedemann" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:9 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Absence of Doppler signal." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1328 "Ancho" => 1305 "Tamanyo" => 232451 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A and B) Abdominal ultrasound scan with visualization of 10 to 15 hypoechogenic space-occupying lesions compatible with hepatic haemangioma. A Doppler signal can be seen in image B. C and D) Abdominal ultrasound scan at 4 months of treatment, in which the hepatic haemangiomas can no longer be seen.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Arantxa Muñiz de Lucas, Elena Naz Villalba, Gonzalo Manuel Botija Arcos, Elena Jaime Lara, Jose Luis López Estebaranz" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Arantxa" "apellidos" => "Muñiz de Lucas" ] 1 => array:2 [ "nombre" => "Elena" "apellidos" => "Naz Villalba" ] 2 => array:2 [ "nombre" => "Gonzalo Manuel" "apellidos" => "Botija Arcos" ] 3 => array:2 [ "nombre" => "Elena" "apellidos" => "Jaime Lara" ] 4 => array:2 [ "nombre" => "Jose Luis" "apellidos" => "López Estebaranz" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1695403323000942" "doi" => "10.1016/j.anpedi.2023.04.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403323000942?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287923001916?idApp=UINPBA00005H" "url" => "/23412879/0000009900000003/v1_202309061009/S2341287923001916/v1_202309061009/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Paediatrics</span>" "titulo" => "A neonate with cystic umbilical cord and wet umbilicus" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "208" "paginaFinal" => "209" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Jazmín Pérez Ramírez, Julio César Moreno-Alfonso, Guillermo Jacobo Serrano Meneses" "autores" => array:3 [ 0 => array:3 [ "nombre" => "Jazmín" "apellidos" => "Pérez Ramírez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "Julio César" "apellidos" => "Moreno-Alfonso" "email" => array:1 [ 0 => "juliomoreno.md@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "Guillermo Jacobo" "apellidos" => "Serrano Meneses" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Cirugía Pediátrica, Hospital Pediátrico Moctezuma, Ciudad de México, Mexico" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Cirugía Pediátrica, Hospital Universitario de Navarra, Pamplona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Doctoral School, Universidad Pública de Navarra, Pamplona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Un neonato con cordón umbilical quístico y ombligo húmedo" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1329 "Ancho" => 1333 "Tamanyo" => 173710 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Umbilical cord with a large cyst measuring 7 × 4.5 cm (A, arrowhead) and umbilical granuloma exuding a yellowish fluid after the cord stump fell off (B, arrow). The fistulogram confirmed the presence of patent urachus (C, arrow) in absence of urethral anomalies (C, arrowhead). The upper and lateral portions of the latter image feature a radiolucent tubular structure, corresponding to the syringe used to inject the contrast agent.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We present the case of a male infant aged 38 weeks with a cystic umbilical cord (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). At 15 days post birth, after the cord stump fell off, an umbilical granuloma became visible that issued a yellowish fluid, found to be urine after performance of urinalysis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B); a patent urachus was suspected, and an abdominal ultrasound scan ordered in which no abnormalities were identified. The fistula was examined by means of a voiding cystourethrogram, confirming the patent urachus (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). At 23 days post birth, a urachal remnant measuring 1.5 cm that extended to the bladder dome was excised through an infraumbilical incision, followed by cystorrhaphy and umbilicoplasty (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The histological examination of the specimen found transitional epithelium, granulation and smooth muscle tissues. The patient had a favourable outcome and was discharged 4 days after the surgery.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Cases of patent urachus associated with umbilical cord cysts are rare. The hypothesis of urinary reflux through the patent urachus with cystic dilation of Wharton’s jelly was proposed 40 years back, and few cases have been described since.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The differential diagnosis of fluid discharge from the umbilicus and umbilical granuloma must include urachal anomalies, especially if preceded by manifestations such as umbilical cord cyst.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Although spontaneous urachal obliteration in the first 6–12 months of life has been described in cases with large urachal remnants and a history of cystic umbilical cord, suggestive of significant urinary reflux (as was the case of this patient), we recommend surgical repair as the preferred approach to lower the risk of infection, acute abdomen and, while rare, malignant transformation in the long term.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0015" class="elsevierStylePara elsevierViewall">This research did not receive any external funding.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1329 "Ancho" => 1333 "Tamanyo" => 173710 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Umbilical cord with a large cyst measuring 7 × 4.5 cm (A, arrowhead) and umbilical granuloma exuding a yellowish fluid after the cord stump fell off (B, arrow). The fistulogram confirmed the presence of patent urachus (C, arrow) in absence of urethral anomalies (C, arrowhead). The upper and lateral portions of the latter image feature a radiolucent tubular structure, corresponding to the syringe used to inject the contrast agent.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1333 "Ancho" => 1333 "Tamanyo" => 186261 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Infraumbilical incision and dissection of the entire length of the urachus (A, arrowhead) extending to the bladder dome (A, arrow). Excision of the patent portion of the urachus (B, arrowhead), three-layer repair of the bladder dome (C, arrow) and cosmetic outcome of the umbilicoplasty (D).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of the giant umbilical cord: challenging the need for investigations in the newborn" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Young" 1 => "A. McGeechan" 2 => "P. Davidson" 3 => "A. Deshpande" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/archdischild-2016-311092" "Revista" => array:6 [ "tituloSerie" => "Arch Dis Child Fetal Neonatal Ed" "fecha" => "2016" "volumen" => "101" "paginaInicial" => "F538" "paginaFinal" => "F539" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27573520" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Umbilical cord cyst with patent urachus presenting as a urine jet from the umbilicus: a case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C.C. Lin" 1 => "C.B. Huang" 2 => "J.C. Su" 3 => "Y.K. Chou" 4 => "K.L. Chiang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.pedneo.2021.07.011" "Revista" => array:6 [ "tituloSerie" => "Pediatr Neonatol" "fecha" => "2022" "volumen" => "63" "paginaInicial" => "105" "paginaFinal" => "106" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34906437" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Are you sure that it is a granuloma?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.E. Carazo" 1 => "L. Rodríguez" 2 => "R. Llorens" 3 => "B. Pemartín" 4 => "C. Gutiérrez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.anpedi.2015.06.002" "Revista" => array:6 [ "tituloSerie" => "An Pediatr (Barc)" "fecha" => "2015" "volumen" => "83" "paginaInicial" => "358" "paginaFinal" => "359" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26169598" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23412879/0000009900000003/v1_202309061009/S2341287923001692/v1_202309061009/en/main.assets" "Apartado" => array:4 [ "identificador" => "77701" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Paediatrics" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23412879/0000009900000003/v1_202309061009/S2341287923001692/v1_202309061009/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287923001692?idApp=UINPBA00005H" ]
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