Presentation
A tender, smooth, reddish mass lesion at the umbilicus associated with serosanguineous discharge. Parents noticed the swelling 4 years ago, and it has been stable in size since then.
Patient Data
Axial B-mode ultrasound image of the umbilicus with a linear probe shows a hyperechoic mass lesion with a hypoechoic rim. Longitudinal and axial ultrasound images with color overlay show a hypoechoic stalk entering the lesion at its base, displaying prominent central color uptake suggestive of a vascular pedicle. No color uptake is noted in the rest of the lesion. Spectral Doppler evaluation reveals a pulsatile arterial waveform in the vessel within the pedicle. No deeper extension of the lesion is observed.
Case Discussion
Umbilical granuloma is the most commonly diagnosed umbilical lesion in newborns and infants. Clinical examination and imaging findings in this case are highly suggestive of an umbilical granuloma, although the presentation is later than usual. Other common pediatric umbilical masses include umbilical polyps, umbilical hernias, urachal remnants, soft tissue masses like hemangiomas, and epidermoid cysts 1. A close differential diagnosis in our case is an umbilical polyp, but these tend to be more deep-seated, less vascular, and may have cystic areas within 2. Hemangiomas tend to be flat and tend to involute by the first year of life 3. Epidermoid cysts tend to have a targetoid appearance on USG with lesser vascularity 1.
Umbilical granulomas are treated with chemical cauterisation using silver nitrate. However, if the lesion is too large or if treatment with silver nitrate fails, surgical excision might be required 1.
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