Differential diagnosis of umbilical polyps and granulomas in children: sonographic and pathologic correlations

PURPOSE: The sonographic differential diagnosis of umbilical polyps and granulomas in children based on correlations with pathologic findings. METHODS: We retrospectively analyzed the ultrasonographic findings of twenty-two umbilical masses in children that were pathologically confirmed as umbilical polyps or umbilical granulomas by surgery. We analyzed size, depth, echogenicity, internal content, intralesional vascularity, and the presence of unobliterated medial umbilical ligament. Pathologic correlation was performed for all of the umbilical masses. RESULTS: Twenty-two masses consisted of eight umbilical polyps and fourteen umbilical granulomas. The mean age of the children with umbilical polyps was 30.13 months (range, 2 to 108 months) and it was 1.33 months (range, 0.6 to 3 months) for the children with umbilical granulomas. The average mass sizes were 10.25 mm (range, 5 to 35 mm) for umbilical polyps and 6.21 mm (range, 3 to 10 mm) for umbilical granulomas. The umbilical polyps were manifested as cystic lesions with thick echogenic walls in five patients (62.5%), which were associated with the intestinal mucosa (four lesions) and ectopic pancreatic tissue (one lesion) on pathology. Umbilical granulomas were superficially located in 13 (92.9%) and solid in thirteen (92.9%), which correlated with prominent granulation tissues on pathology. Seven (87.5%) of the eight umbilical granulomas were hypervascular and correlated with neovascularization on pathologic examination. CONCLUSION: The umbilical polyps revealed deep-seated, hypovascular nodules with cyst formation surrounded by thick echogenic walls. In contrast, the umbilical granulomas revealed superficially located hypervascular hypoechoic solid nodules in young infants.