Q. I am a registered nurse whose recent ultrasound showed the following: 'In the mid line situation above the uterus but adjacent to the anterior abdominal wall, there is a fluid filled cystic mass measuring 3.3×1.8×2.65 (volume 8.5 cc) This may possibly be a urachal cyst. The nature however is indeterminate. No significant ovarian or uterine abnormality is shown.' I saw five doctors in Australia, where three said they would not operate. Two German doctors said the mass is possibly external endometriosis. Another German doctor prescribed medication for me to dissolve the cysts. He said these cysts may dissolve by themselves. He, too, does not recommend surgery. I do not have a urachal cyst. Four years ago, I had a pelvic ultrasound that showed no cysts. The past two years have been stressful, and I wonder if my condition is stress-related. I had two children, each born in 1980 and 1982. I have scant periods, every 25 days. I've also had abdominal pain for possibly more than six years. For the past 10 years, I have had normal blood chemistries, with the last one in November. What sorts of testing and remedies do you suggest?
A.The urachus allows the urine to drain from the bladder out the umbilicus when an infant is in utero. This passage closes at birth, but a cyst may develop and collect urine later in life. While the umbilicus cyst is present from birth, it is possible for it to grow larger over time, and so it may have been missed on your earlier ultrasound. Still, I agree with you. It is not the only thing we should be concerned about in your case. Another possibility is a cyst involving the ovaries (you did not rule that out in your description of the ultrasound). Endometriosis (as your doctors had told you) or cysts of another structure are possible. The ultrasound is excellent at evaluating these structures, but sometimes another technique such as a CT scan will provide additional information. Certainly, surgery is a possibility, but only necessary if the cyst causes significant problems or problems in the future.
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