A 4 week-old female infant presents due to yellow discharge from her umbilicus and mom noticing a red mass coming from the umbilical area after changing her diaper today. She is a healthy infant born at 40 weeks by vaginal delivery without complications and weighed 6 lbs 1 oz at birth. She is feeding 4 oz of formula every 3-4 hours. She received immunizations at birth and has an established pediatrician.
General: Well appearing infant who smiles and coos
Abdominal: Soft abdomen, normal bowel sounds, non-distended, no erythema, no swelling, no warmth of skin. The inferior aspect of the umbilicus has a soft, moist appearing, beefy red mass-like protrusion.
Umbilical granulomas are most often treated successfully with Silver Nitrate application. Often multiple applications are needed for full resolution. Some advocate for application of salt crystals instead.
An umbilical granuloma is non-emergent and the most common cause of an umbilical mass. They usually form within the first week after cord separation. Often described as moist and pink, they range in size from 1-10 mm and can be associated with some sanguineous or even greenish discharge.
Take Home Points
An umbilical granuloma is the most common cause of an umbilical mass.
Umbilical granulomas are treated with topical silver nitrate application and often require multiple applications.
Images and cases from the Society of Academic Emergency Medicine (SAEM) Clinical Images Exhibit at the 2019 SAEM Annual Meeting | Copyrighted by SAEM 2019 – all rights reserved. View other other cases from this series on ALiEM.