sbellin Posted September 17, 2012 Share Posted September 17, 2012 I had an interesting case recently I’ll share. An 8 year old male is brought to my clinicwith a vague LLQ pain for two weeks which is slightly worse with voiding. His appetite and bowel and bladder habits arenormal. He still continues in sportswhich include martial arts classes. Examshows him to be afebrile and with minimal LLQ pain on palpation; no suprapubic,RLQ pain, or guarding. Urine was negative. After discussion with both parents we decided to take a watch and waitapproach. Three days later (Friday) theycalled and said he was a little more uncomfortable and a two view abdomenseries showed normal gas pattern and they were to call me over the weekend ifhe got worse. The following Wednesdaythey called and reported increased pain and overnight fever of 100.5. He was seen again in the clinic and found tonow to have fullness and tenderness in the suprapubic region with slight RLQtenderness. There was now little LLQtenderness. Repeat U/A againnegative. CBC showed WBC 13.7 and slightleft shift. U/S showed suprapubic solidand cystic mass. CT revealed again solidand cystic mass to the left of the bladder that was compressing and displacing thebladder to the right. Being in a ruralarea without regular surgical services I discussed the patient with theregional children’s hospital and arranged transfer to them. The child was diagnosed with a urachal cystand had a drain placed and after antibiotics will return for removal. I must admit that this diagnosis wasn’t on my radar havingnever heard of a urachal cyst before. Myresearch places them as a fairly rare disorder frequently presenting as a dischargefrom the umbilicus and can present at any age. Anyone with other experiences with urachal cysts? Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted September 17, 2012 Moderator Share Posted September 17, 2012 nope. nice work up and follow through. I get weird stuff like this every now and then at my rural er job and only find out weeks later what the final dx was after transfering them to tertiary care ctrs. Link to comment Share on other sites More sharing options...
Guest Paula Posted September 17, 2012 Share Posted September 17, 2012 About four years ago when I worked in UC/ER we had a man come in with discharge from his umbilicus, mild abdominal pain, and expanding erythema around the umbilicus. CT showed a urachal cyst. I had never seen or heard of it before either. If I remember correctly, he had his surgically fixed. The doctor vaguely remembered studying this in school, but it wasn't on his differential either.:smile: Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted September 17, 2012 Moderator Share Posted September 17, 2012 http://en.wikipedia.org/wiki/Urachal_cyst scary stuff.... Link to comment Share on other sites More sharing options...
primadonna22274 Posted September 18, 2012 Share Posted September 18, 2012 I have heard of it...in med school embryology ;) don't expect to see one though. Interesting pickup. Good for you being vigilant and having such a strong relationship with patient and family :) Link to comment Share on other sites More sharing options...
Hemegroup Posted September 24, 2012 Share Posted September 24, 2012 nice work. caught an arachnoid cyst in a 5 year old mistakenly dx as 'autistic' the other day, accidentally from the kid who pushed him on the playground. kid deserves a medal! Link to comment Share on other sites More sharing options...
Hemegroup Posted September 24, 2012 Share Posted September 24, 2012 I have heard of it...in med school embryology ;) Isn't it interesting how all fetuses are inherently female in the first 6 weeks? I remember that from Human Development ... sort of explains the drive for males to try and dominate females. Pity tho, no hard we try to compensate, we'll never be first ;) Now as for that 'God in Man's image' bit ... sort of puts a different sort of twist to it, doesn't it? Shinto Buddhism teaches that the Mother Sun births the Buddha. Nicely appropriate-ish, after all. Link to comment Share on other sites More sharing options...
Guest JMPA Posted September 24, 2012 Share Posted September 24, 2012 Isn't it interesting how all fetuses are inherently female in the first 6 weeks? I remember that from Human Development ... sort of explains the drive for males to try and dominate females. Pity tho, no hard we try to compensate, we'll never be first ;) Now as for that 'God in Man's image' bit ... sort of puts a different sort of twist to it, doesn't it? Shinto Buddhism teaches that the Mother Sun births the Buddha. Nicely appropriate-ish, after all. so this is now a religious forum? ok, well for one it is "man was made in the image of God", not the other way around. seems like someone has an inferiority complex Link to comment Share on other sites More sharing options...
Hemegroup Posted September 25, 2012 Share Posted September 25, 2012 so this is now a religious forum? ok, well for one it is "man was made in the image of God", not the other way around. seems like someone has an inferiority complex didn't like my twist on things? lol ... man in god's, god's in man ... just leave the female out, that's the important part! heaven forbid males feel inferior ... even though the fact remains, we will never be first. tough sh*t. now go vote for equal wages for both genders and show some appreciation for your roots! and i think you meant superiority complex ... well, look up the origin/etymology of the word "God" and you'll get where i come from ... it's all words ... if you don't find my points to be of interest, there's really no one forcing you to comment on them. actually, you didn't did you. maybe you're having a hard time dealing with embryology? i'll stand with you, i'll hold your hand ... it's going to be okay! Link to comment Share on other sites More sharing options...
Guest JMPA Posted September 25, 2012 Share Posted September 25, 2012 seek help it out there Link to comment Share on other sites More sharing options...
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