Sonographic Diagnosis of a Large Urabilical Cord Pseudocyst Craig S. Kalter, MD, Mark C. Willams, MD, Victoria Vaughn, RDMS, RDCS, William N. Spellacy, MD Ubileal cod cysts ae uncommon findings at deliv ery, With improvenents in sonographic technology Sand the wider appiation of this imaging method, these cysts have been detected antenataly and at ele station times. This presents the bsteiian ‘with a management dlomma. Unbilcal cord ests have mute causes and have been associated Wilh sti." summary of case reports, associated Snomalics, and ouomes in points witha prenatal Glagnoss of umbieal cord ys given in Table 1 These cyss have ben found to be assodated with sneupoidy when cther abnormalies are preent** erst bnmeter uel cra jets that are nok accom nied by other abnormaliies and resolve on fal fow-up ulirasonognphy haves normal outcome. We epot the case of prenatally detected iarge mbical ford pseudocyst wih sociated strturalabnormal- iis and a normal aryoype ‘Table 1+ Cazes witha Prenatal Diagnosis of Umblical Cord Cyt ndings oa ‘shor in Aadton to Cys) = ‘enimehle® Gales et and elena Normal 19, syed nie Side Medel Tone and Unley of foe Bees SE A Sedu nag ieee ssupeng nan arn al (Glaser lated cs ot 2 weeks Normal Constantine? (1) Porte fous ea ites Teo 18 ‘eine wth rear (2) immoutene growth eta Tomy 18 Hphes Cyt cond mass Nena Jruninut——(])Hyaop etl singe Teomy 16 ‘ambiente 2} Omphalase omy 18 S38 Rigas Noma Zenit Hoopronencephaly single Teomy 19 bel artery CASE REPORT [AAT year spank gravida 2 part woman cme to ounty heath department cn for her est prenatal vi ot ‘Tse of geston The pst mele hry reveled no Signin ea ese. Her past otter tory wos ‘Spontneaus vaginal deivery of 260 g normal ale inant term. The phys amination wat unrenaratle © 195 the Amen ite of Ueto in Maisie «J Ulan Med 1357-489, 184 + Go2975459.50468 UMBILICAL CORD FsEUDOCYST Figute 1 Sonographic sppenanc fan are ofthe ei Teron dplcng the wees aly escopt for» fund ight of 27m. case ofthe ste ‘ttt dcrepancy,sonopepe xaioson was Ove [i choweds ingen ts tt ipsa ree, fer hand head and abdominal eeuetenes content ‘Sub a wens ofgeaton Tow eat eal weight Masog mh petele fr 3 wens) A treet ‘Shiba dnd was noted witha aor pon inerion. ‘large anechol eye mass metsurngs > cm wae sen Toth the wba cord Inert nt he fer ‘Thdomen A seprestnative cee ofthe jt shown in Figure No addtional sbnomapte were Steed. Tee tile wsls append forum song ie sure ofthe “SA Dope fw anaes of the umber gave Seo er Aas seperate Pen ofureda genetic mmocees which was fered ‘iho of te soeiton tetween ambi opts and reply, A tegeled snogope stamunaion 1 eae 1 lr other abmornaiee as shee he flowing ‘recs however the patent dd not tum fot her appa “he sent rtm in aor daring the Ast weok of gestion and «2560 male int wos dled spon eos wih Apgar stores oat a and 5 mites, ‘apecely. Th aul here was normal ding bor. ‘Alege der est ensuring 8 cm ¥ 3m was fund neat ‘he om leerion oft ord Physic exriation ‘lth newtor revealed a bie sro, coronal hypespe. Sue nso dimple wi 2 Sel ad a iperforte Stu 'Anasogaste ibe wat pated easly oe stom ‘Shand im plato venod 6 an abdominal rdogeph Tedddope bahnton of the hmokescal sen dene ‘raed mile wert faion mallormations oes Sto thecal tp. Rasogrpi tthe exes were ue Inala No sheeraekite were found on renal ot Snography.Thebaby was tenth opening room and 2 derang clatomy was tshioned.Ineoperatve Nid Inge were consent tha high srl avess and isa, ‘econiamled recived lon. The tla Was 5- 1 Ulead Mad 947-459, 1004 Figure 2 Geos appearance of unbhal cord psudoryst ett was ere courelng arg homeo the 11 day of ie trating mca Stee Hee doing well at 1'morth of ie vihowt any Spperen sional problems Alay ays of he Mls tood showed 462% complement Tea fhe ‘tlic conden showed mane ora ard mnered Sie tom: The umbllen vers our hugh be ‘massand were dsended (g.2) Mccsope aminton Showed mungveedeow with degenaton © Wheres Inty and fomaton se paces. The specmen fi Imo on evened only site mc! ged sumac Remontage. DISCUSSION Cynic structures within the cord may bea rue cyst 4 preudocyst True tmbileal coed cys ongiate from amlote inclusions, remnants of fe ompha- lomesentere dct the allanol, cr vascular malo. mations, A pseudocyst is 2 cavity tha forms fom degeneration of Wharton's ely and has no epithehal lining. Often tis not possible Yo define the cause of these cyt prenatally. Umbilical cord ey detected inthe fiat ester that reslve do ret appear to ‘ute fetal compromise Ina sels of eight umbilical ord cats detected between Band 9 week gest, cysts had resolved by 12 weeks In te five po {ents followed to term, none had am saomaly de tected at bith, Inthe one patient for wom patho- logic examination was reporial, a cjst lined by ‘oie type epithelium compatible wit an ani ‘te inclusion wes found. “The vtline or omphalomesenteie duis a con- nection between the fetal midgut and ther Yolk sa This structure normally i oblterted by Zppronnately the Sth developmental wiek* Rem ‘ants ofthis duct usually are located beneath the) Ursesound Med 18487485, 198 amniotic surface of the cord and ate Used by Hat or otumarepitheluss? This lining may aserentate Ino gastric or other gastoinestia epithelia Castic {54 om an omphlomesenterc cyst Ras been poe Tulated asa cause of lceration though the umbilical ‘estes with fetal hemorshage and death * "The exraembryon=sllntls degenerates alter the Gah week of development Nevertheless, remnants tay be identified as cyst ined by Mat or caboial fle esembling wansitonal epithet The Br ‘eport of allantoic ests detected sonographicaly Was pbllhed in 1982” Frasier and coworkers recently feported a patent urachus in assoition with an a> laniole ct detected. sonogeyphaly” Caution Should be excised when cutting the cord of an fnfant with on rslicaleyst because transection of 3 patent urachus can result in formation of «velco ‘Seminal etl, Peculeyst formation resus fam liquefaction ot mucoid degeneration of Wharton's jelly. Bergman land colleagues reported two eases in 1861, one of which had widesprend este mucoet degeneration of ‘Wharton's jelly with delivery ofa normal 3220 baby at tem. The second cate was aterm silborn with Iicold degeneration of Wharton’ ely with ares of the umbiel artery rendezed Bare” A repor by lac- caring and assoistesdesrbes 228 week ots found tn allresonogeaphy to have growth retardation and a Fon umblicl cord mass compressing the wmblcal ‘sels The pregnancy Wat terminated and histo- logle examination revesed mucoid degeneration of {he unblcl cord and thrombin the vessels" Five ‘res of aneuploidy in association with umbcal cord poeudocyt have been reported in one of there, {he unbal ord yst and symmetric growth retar- daon were the only abnommalites detected. Beir Sthke and: Kaufmann have discvised cysts and ‘edema ofthe umbilal cord and indued ant Muse tion of lesion ideneal to this ease "The current cate is unique in that mltipe compo nents of the VATER assodalion (vertebral defects, nal tres, tacheowsophageal atresia radial and re- ‘nal dysplasia) were found a birh in an infant withan [solated large umbilical cyst and » normal baryotype. ‘This infant was found to have ana atesl,gentour nary anomalies, and verbal fusion abrocalites. ‘Arabs ofthe ub cord reveled mative ma id degeneration of Wharton’s ely with peeudocyt formation. We are unaware of prior reports of ao Ciation between VATER type anomalies and uss teal cord preudocyst. "The perstence of an umbilical cord cyst should romp farther evaluation, A_ karyotypic stidy Should be encouraged when other anomalies are found, The tse of olor ow or pulsed Doppler st toe may be considered. This can delinate a vascular onormaly suchas glane dation ofthe umbllcal, ‘ein from & ejee cord lesion. In addin, it may provide data regarding the cysts effect on ood ow, as varcar compromise has been found by othe authors. An enlarging mass may compromise Umbc blood fow and antepartam fetal testing say be incre in thi sation, REFERENCES SEES Waco’ lye Anubis {Heetning lies Nn Ob Gynec Sena 1 2. Juniaus E, Donne G, Thomas ta: Umbeal ord Pesucyt ie tz 18. Pent Doge 8387, 1088 2. Constamine G, Andean ,Fvie A: Umbieal cord Peo eye Pent Baga ar, Zea, Dall: Unbteal cod pacudoeyat in ‘anoy 15 ater Prevat Diagn 9488, 1888 5, Skibo LK Lone EA, Lal CS Fs trimester ub led et Daly 12798, 1992 6 Moore Ke The Developing Human, Sed EA. hide har WB Srunden, BD p28 7 Geel J, Kaus FT, Re MB: Dseses ofthe pa ‘ois Karman (Blasters Paty fe aomie Genial eed Now York, Spnger Vong 978 8. 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