A giant umbilical cord (GUC) is a rare malformation diagnosed by prenatal ultrasound or inspection. The differential diagnosis includes umbilical cyst, patent omphalomesenteric duct, patent urachus, omphalocele, and vascular malformations (1). We report a case of a GUC pseudocyst to aid visual diagnosis and guide management.
After an uncomplicated pregnancy, a term female infant was born to a 30-year-old primigravida by Caesarean section because of a nonreassuring fetal heart rate. A 4-cm GUC was discovered postnatally, which was not identified on prenatal imaging (Figure 1).
Figure 1.
Infant with a giant umbilical cord diagnosed at birth.
No resuscitation was required after delivery. Cord blood gases were within normal limits, and the cord was clamped above the cyst (Figure 2). Ultrasound of the umbilicus revealed a fluid-filled cyst without associated urinary tract anomalies. Pathology confirmed an umbilical pseudocyst. No surgical intervention was required as there was no connection to the bladder. The newborn’s course was subsequently uncomplicated in the few months after discharge.
Figure 2.
Umbilical cord pseudocyst with clamped cord.
Umbilical cord cysts have a prevalence of 0.4 to 3.4% and are typically visualized on prenatal imaging. Cord cysts are classified as either true cysts, derived from the embryological remnants of the allantois, or pseudocysts, arising from liquefaction of Wharton’s jelly. On histology, pseudocysts lack an epithelial lining (2).
Cord cysts can be associated with a patent urachus, a malformation affecting 1 to 2.5:100,000 pregnancies (1). It is hypothesized that fetal urine flows through the patent urachus into the cord, causing swelling of Wharton’s jelly (1). Further embryologic explanations have not been elucidated.
Umbilical cysts found in pregnancy warrant additional surveillance. Pregnancies should be monitored with serial ultrasounds for associated urinary tract anomalies, especially a patent urachus, and abdominal wall defect (2). Karyotyping should be performed given increased incidence of aneuploidy (1). Advanced delivery planning is imperative, as fetal demise can occur from vascular compromise when cysts are large or numerous (2). Postnatally, most GUCs can be managed conservatively in the absence of associated anomalies (3).
Informed Consent: Consent was been obtained from the family.
Funding: There are no funders to report for this submission.
Potential Conflicts of Interest: All authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.
References
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