Umbilical concretion

Abstract

Umbilical concretion is a rarely encountered benign entity. Concretions typically form within an umbilical cleft which is unusually deep and consist of keratinaceous and sebaceous material. Lack of attention to umbilical hygiene usually plays a role in their formation. Concretions are generally asymptomatic and may only present clinically when complicated by inflammation or infection. Their appearance on imaging studies may be problematic for the radiologist given their rarity, particularly in the setting of a known or suspected intra-abdominal malignancy.

Keywords: Umbilical concretion; omphalith; omphalolith; umbolith.

Figure 1a

85 year old woman with umbilical concretion. Axial contrast enhanced CT of the abdomen and pelvis shows a rounded non-enhancing soft tissue density with well-defined margins within the subcutaneous tissues of the anterior abdominal wall near the level of the umbilicus (arrow). (4.0 mm axial CT reconstruction from a venous phase acquisition at 120 kVp and 223 mAs on a Philips 64-slice scanner following intravenous administration of 100 mL of Isovue-370.)

Figure 1b

85 year old woman with umbilical concretion. Axial contrast enhanced CT of the abdomen and pelvis shows a rounded non-enhancing soft tissue density with well-defined margins within the subcutaneous tissues of the anterior abdominal wall near the level of the umbilicus (arrow). There is linear calcific density at the most superficial aspect of the lesion (curved arrow). (4.0 mm axial CT reconstruction from a venous phase acquisition at 120 kVp and 223 mAs on a Philips 64-slice scanner following intravenous administration of 100 mL of Isovue-370.)

Figure 1c

85 year old woman with umbilical concretion. Axial contrast enhanced CT of the abdomen and pelvis shows a rounded non-enhancing soft tissue density with well-defined margins within the subcutaneous tissues of the anterior abdominal wall near the level of the umbilicus (arrow). Slightly more inferior slice shows the mass lesion to be directly communicating with air at the level of the umbilical cleft (curved arrow). (4.0 mm axial CT reconstruction from a venous phase acquisition at 120 kVp and 223 mAs on a Philips 64-slice scanner following intravenous administration of 100 mL of Isovue-370.)

Figure 1d

85 year old woman with umbilical concretion. Coronal image from contrast enhanced CT of the abdomen and pelvis shows a rounded non-enhancing soft tissue density with well-defined margins within the subcutaneous tissues of the anterior abdominal wall near the level of the umbilicus (arrow). (3.0 mm coronal CT reformat from a venous phase acquisition following at 120 kVp and 223 mAs on a Philips 64-slice scanner intravenous administration of 100 mL of Isovue-370.)

Figure 1e

85 year old woman with umbilical concretion. Axial contrast enhanced CT of the abdomen and pelvis shows a rounded non-enhancing soft tissue density with well-defined margins within the subcutaneous tissues of the anterior abdominal wall near the level of the umbilicus. Slightly more superficial slice shows the mass lesion to be directly communicating with air at the level of the umbilical cleft (arrow). (3.0 mm coronal CT reformat from a venous phase acquisition at 120 kVp and 223 mAs on a Philips 64-slice scanner following intravenous administration of 100 mL of Isovue-370.)

Figure 2a

85 year old woman with umbilical concretion. Transverse image from sonographic examination employing color Doppler imaging shows ovoid heterogeneous, predominantly hypoechoic, solid nodule near the level of the umbilicus. The lesion causes some shadowing and there is no intranodular vascularity. (Static image from sonographic examination with linear 12 MHz transducer.)

Figure 2b

85 year old woman with umbilical concretion. Sagittal gray scale image from sonographic examination shows ovoid heterogeneous, predominantly hypoechoic, solid nodule near the level of the umbilicus. The hypoechoic curvilinear structure inferior to the nodule likely represents part of the deep umbilical cleft (arrow). (Static image from sonographic examination with linear 12 MHz transducer.)

Figure 2c

85 year old woman with umbilical concretion. Follow up ultrasound imaging for biopsy planning. Transverse image from sonographic examination employing color Doppler imaging shows no change of the ovoid heterogeneous, predominantly hypoechoic, solid nodule near the level of the umbilicus. There is no intranodular vascularity. (Static image from sonographic examination with linear 12 MHz transducer.)

Figure 2d

85 year old woman with umbilical concretion. Follow up ultrasound imaging for biopsy planning. Transverse gray scale image from sonographic examination shows ovoid heterogeneous, predominantly hypoechoic, solid nodule near the level of the umbilicus. There is linear hyperechogenicity (arrow) causing shadowing (curved arrow) which correlates with the linear calcific density seen on CT examination. (Static image from sonographic examination with linear 12 MHz transducer.)

Figure 3

The evacuated umbilical concretion measured approximately 2 centimeters in length. The concretion was predominantly soft and pearly white, with a very firm dark brown cap which was visible upon physical exam.

Figure 4a

85 year old woman with umbilical concretion. Follow up ultrasound imaging. Transverse gray scale image from sonographic examination shows no residual abnormality post non-invasive evacuation of umbilical concretion. Ultrasound transmission gel fills the deep umbilical cleft (arrow). (Static image from sonographic examination with linear 12 MHz transducer.)

Figure 4b

85 year old woman with umbilical concretion. Follow up ultrasound imaging. Transverse gray scale image from sonographic examination shows no residual abnormality post non-invasive evacuation of umbilical concretion. Ultrasound transmission gel fills the deep umbilical cleft. (Static image from sonographic examination with linear 12 MHz transducer.)