ARRS 2022 Abstracts

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E1417. The Unusual Anatomy and Pathology of the Space of Retzius
Authors
  1. Janki Patel; Mount Sinai Hospital
  2. Arielle Sasson; Mount Sinai Hospital
  3. Eric Wilck; Mount Sinai Hospital
  4. William Simpson; Mount Sinai Hospital
Background
The space of Retzius, also known as retropubic space, is an important anatomic location for pathology. This space is named after Anders Retzius, a Swedish anatomy professor. It is confined anteriorly by the pubic symphysis and posteriorly by the urinary bladder. It is separated from the anterior abdominal wall by the transversalis fascia, which extends to the level of the umbilicus. Understanding this anatomy and the embryologic development of the urachus improves the diagnosis of disease in the space of Retzius. The purpose of this educational exhibit is to provide an overview of the pathologies in the space of Retzius.

Educational Goals / Teaching Points
Knowledge of the anatomy and embryological development of the space of Retzius is key in identifying anomalies that may require medical or surgical intervention. The space of Retzius will be anatomically defined followed by a case series of different pathologies seen in this space.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Several pathologies in the space of Retzius include a urachal cyst, patent urachus, umbilical-urachal sinus, and vesicourachal diverticulum. There are potential complications including infection of the urachal remnant. Other pathologies include fluid collections within the space of Retzius (e.g., hemorrhage, contrast infiltration), umbilical granuloma, umbilical endometriosis, benign urachal tumors, umbilical metastases, and malignant urachal tumors. Some of these pathologies will be reviewed via case examples. Case 1 is a 54-year-old woman presenting with severe abdominal pain. CT demonstrates a necrotic mass with mildly thickened walls containing a tiny amount of gas, suggesting fistula to the colon. The mass measures 2.3 × 1.7 × 2.1 cm and is seen anterior and superior to the urinary bladder. There are perivesicular inflammatory changes and tethering of adjacent thick-walled cecum and sigmoid colon. This patient was diagnosed with locally advanced urachal carcinoma. Case 2 is a 32-year-old man with abdominal pain and umbilical discharge. CT scan shows a thick-walled collection measuring 2.8 cm within the abdominal wall at the umbilicus with extensive soft tissue infiltration and extension to the skin. This collection appears extra-peritoneal and is associated with the urachal remnant. This patient was diagnosed with abscess of a urachal cyst. Case 3 is a 55-year-old woman with hypotension and dropping hematocrit status post-angiography for ischemic stroke. A right femoral catheter is present. There is extensive extraperitoneal hemorrhage into the space of Retzius, extending along the left pelvic side wall to involve the iliopsoas muscle. This patient was diagnosed with hemorrhage within the space of Retzius.

Conclusion
The space of Retzius is an often overlooked anatomic location that can contain various pathologies. Understanding the anatomy and embryology of the space can improve the diagnostic accuracy of radiologists. There are several important pathologies within this space, both benign and malignant, that should not be overlooked for appropriate patient management.