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The article focuses on the case of a 5-year-old girl presenting with unintentional weight loss and abdominal distension, which led to the discovery of ascites and other concerning findings. Topics include her travel history and potential exposure risks, the diagnostic workup including imaging and laboratory results, and the clinical presentation of her condition.

Objectives: To assess needle placement accuracy in the rectus abdominis (RA) muscle during dry needling (DN) without entering the peritoneum. Methods: Two physical therapists performed DN on a cadaver, making 10 attempts each to needle the RA without entering the peritoneum. Techniques followed two common DN approaches. Ultrasound verified needle depth and safety. Results: Seventy percent of attempts were recorded as safe needle placement, while 30% were unsafe. Accurate RA needle placement without peritoneal entry occurred in 55% of attempts. Discussion/Conclusion: Inadvertent peritoneal needle placement during RA DN poses risks regardless of experience. Ultrasound guidance may enhance safety and precision in clinical practice. [ABSTRACT FROM AUTHOR]

Serous borderline tumors of the ovary fall in between the benign and malignant category. These tumors are often diagnosed early, and the prognosis is usually favorable. However, there are variations in the histopathological findings of borderline ovarian tumors. Xanthomatous change is one such rare change in which deposition of lipid-rich material is seen morphologically as xanthoma cells within tumor tissue and reports of this are sparse. There is postulated literature on xanthomatous change being a contributing factor for progression of cancer. We present a case of a 75-year-old postmenopausal female with complaint of pain abdomen since 3 days, diagnosed radiologically as right ovarian mucinous cystadenoma/cystadenocarcinoma. Histopathology revealed a serous borderline tumor with extensive xanthomatous change. This case presents important thoughts on exploring the connection of xanthomatous change with borderline ovarian tumors, which till date is a matter of debate. [ABSTRACT FROM AUTHOR]

Patients with tumor thrombosis in the portal vein due to hepatocellular carcinoma (HCC) are uncommon, and the majority of these cases is thought to be in an advanced stage with a bad prognosis. The right atrium and the inferior vena cava may be impacted by the intravascular tumor thrombus, with the latter having a bad prognosis. Portal vein involvement is one of the most serious consequences of HCC. For both systemic and locoregional therapy, targeting many pathways in the HCC cascade using a mix of medications and additional modalities like transarterial chemoembolization, transarterial radioembolization, radiation, and hepatic arterial infusion chemotherapy appears to be helpful. Portal vein tumor thrombosis, which affects 35 to 50% of patients, is a strong predictor of poor prognosis due to the higher likelihood of tumor migration into the bloodstream and the subsequent increased risk of recurrence. This case report highlights about a 60-year-old female who presented with HCC with portal vein tumor thrombosis not willing for chemo- and radiotherapy successfully treated with transarterial chemoembolization as a palliative management. [ABSTRACT FROM AUTHOR]

Background: Metabolic dysfunction-associated steatotic liver (MASLD) disease is the commonest hepatic cause of liver fibrosis and cirrhosis after the introduction of the direct acting antivirals and eradication of hepatitis C. MASLD is usually associated with metabolic syndrome and elevated inflammatory markers. Magnetic resonance spectroscopy (MRS) offers a non-invasive diagnostic, alternative to liver biopsy. This is a case–control diagnostic-accuracy study conducted on 40 patients in the Hepato-gastroenterology Unit in the Internal Medicine Department, Ain Shams University Hospitals, to study the role of MRI spectroscopy as a new diagnostic model for assessment of liver steatosis in non-diabetic MASLD patients compared to the standard ultrasound and clinical criteria. MASLD was diagnosed by a combination of a validated ultrasound hepatic steatosis score grading system and hepatic steatosis index using clinical and laboratory parameters. MRS was performed in all patients and fat peak, water peak, and fat fraction % were measured, and diagnostic accuracy of different MRS is compared to the US scoring and different laboratory and clinical parameters. To our knowledge this is the first study conducted on MRS in our region and Egypt. Results: This study revealed no statistically significant difference between the two groups regarding HbA1C, creatinine, while there was highly statistically significant difference regarding fasting blood sugar, 2 h post-prandial glucose level, urine albumin, and low-density lipoprotein levels. Hepatic steatosis score grading by abdominal ultrasound on the 20 controls showed no fatty changes with grade 0 (50%), and on the 20 MASLD patients showed that 2 cases were grade 1 steatosis (5%), 9 cases were grade 2 steatosis (22.5%), and 9 cases were grade 3 steatosis (22.5%). The diagnostic accuracy of predicting hepatic steatosis using different MRS parameters: fat peak, water peak, and fat fraction had area under the curve of 99.9%, 88.6%, and 100%, respectively. The sensitivity and specificity of fat fraction in detecting hepatic steatosis were 100%. The sensitivity and specificity of the fat peak in detecting hepatic steatosis were 100% and 95%, respectively. Moreover, the sensitivity and specificity of the water peak in detecting the hepatic steatosis were 88.6% and 85%, respectively. There is a statistically significant correlation between the three MRS parameters and the abdominal ultrasound hepatic steatosis score grades. Conclusion: MRS parameters: fat fraction, fat peak, and water peak, have high diagnostic accuracy for predicting the liver steatosis. Moreover, MRS has the added advantage of being a non-invasive and a tool with low radiation risk. MRS also shows the metabolic changes in the liver and could be an eligible outcome in therapeutic clinical trials. [ABSTRACT FROM AUTHOR]

Background: Posterior reversible encephalopathy syndrome (PRES) is an uncommon neurological disorder which is characterised by variable symptoms. The transient clinical condition may be underestimated and misdiagnosed as other conditions, especially, among pregnant women with severe preeclampsia, eclampsia, and HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome in the puerperium. We hereby contribute to the literature this rare complication and hightlight the appropriate management of PRES. Presentation case: A pregnant woman (gravida 3, parity 2) had a normal antenatal course. However, she was diagnosed with severe preeclampsia and HELLP syndrome at 29 weeks and 5 days of gestation. Therefore, she was indicated for a medical termination of pregnancy following a patient's consent at our tertiary referral hospital. Severely, the patient developed rapidly with altered mental health in early puerperium. In result, PRES was diagnosed based on a brain magnetic resonance imaging (MRI) evidence with typical findings. After a strict multidisciplinary management, the clinical condition improved after 5 days of onset and recovered completely after a 4-month follow-up without any sequelae. Conclusion: In summary, despite its rarity, clinicians ought to be knowledgeable and raise an aware of PRES during pregnancy. Importantly, a brain imaging modalities should be taken into account among pregnant women with neurological symptoms subsequent to severe preeclampsia. In addition to early diagnosis, a timely appropriate treatment with multidisciplinary team is strongly indicated. Further studies with a large case series are required for this uncommon entity. [ABSTRACT FROM AUTHOR]

Solid pseudopapillary tumor is a mixed solid and cystic neoplasm of the pancreas which occurs most commonly in females in second or third decade of life with few reported pediatric cases. It has a low malignancy potential with good prognosis after surgical resection. We present a case of an 11-year-old male child with solid pseudopapillary tumor of pancreas who presented with clinical features of acute pancreatitis. He was initially evaluated with ultrasound, followed by computed tomography (CT) and magnetic resonance imaging (MRI). Solid pseudopapillary tumor of pancreas presenting as acute pancreatitis is rarely reported in literature. This case is a unique presentation of a pancreatic tumor and highlights the value of multiphase CT imaging and MRI in the diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: Patients with intraductal papillary mucinous neoplasms (IPMNs) exhibit a high incidence of pancreatic cancer. An IPMN presents as a pancreatic cystic lesion (PCL). Artificial intelligence (AI) can be used to enhance ultrasonographic images. We retrospectively evaluated the utility of AI‐assisted ultrasonography in terms of PCL detection. Methods: In total, 969 patients who underwent artificial narrow intelligence‐assisted transabdominal ultrasound examinations (AI group) were compared with 943 patients who underwent non‐AI‐assisted examinations (control group). The morphological changes and the frequencies of newly detected PCLs were compared between the groups. Results: The PCL detection rate was significantly higher in the AI group than in the control group (1.25 ± 0.36 and 0.21 ± 0.15%, respectively; p =.008). AI‐assisted ultrasound evaluation was independently associated with enhanced PCL detection (odds ratio: 5.83, 95% confidence interval: 1.29–26.29, p =.02). PCLs smaller than 8 mm and all PCLs in the pancreatic tail were detected in the AI group. PCL morphological changes were more common in the AI group than in the control group (63.6 ± 14.5 and 16.7 ± 15.2%, respectively; p =.04). Conclusion: AI‐assisted transabdominal ultrasonography enhances the PCL detection rate. The use of AI is likely to increase the IPMN detection rate. [ABSTRACT FROM AUTHOR]

Disorders of sex development (DSD) result from intrauterine defects in sex discrimination. The clinical phenotype differs based on the disease type. Cases with ambiguous external genitalia are diagnosed at birth. However, diagnosis of cases with normal-appearing external genitalia may be delayed until puberty. Here, we report a patient with a pelvic mass and a small uterus that was diagnosed by abdominal ultrasound, in addition to the history of primary amenorrhea and physical examination suggested Swyer syndrome, confirmed by genetic karyotyping. Pathological examination of the surgically removed mass revealed dysgerminoma. Until the age of 19, the patient did not have any idea about 46, XY karyotype, and assumed to be a female. The development of dysgerminoma (as a result of the simultaneous presence of gonadal dysgenesis and Y-chromosome) was another challenge that the patient had to deal with. The diagnosis of this patient at an earlier age could have prevented the development of gonadoblastoma, by removal of the streak gonads. By the presentation of this case, we intend to increase the physician's awareness about DSDs; earlier diagnosis may help the patient deal with her disease better and reduce the risk of further complications. [ABSTRACT FROM AUTHOR]

In summary, squamous cell carcinoma (SCC) of the gallbladder, although rare, poses significant diagnostic and therapeutic challenges. We report the case of a 51-year-old woman with no previous medical history, with SCC discovered during complicated cholecystitis with cholangitis, treated by palliative chemotherapy, underscoring the difficulty in early detection and the poor prognosis associated with advanced-stage diagnosis. Treatment options are limited, with palliative chemotherapy often being the primary recourse for unresectable tumors. Gallbladder cancers, including SCC, share risk factors with adenocarcinomas, but their distinct histopathological features and clinical presentations warrant careful consideration. Despite recent advancements in treatment modalities, including adjuvant therapy, optimal management strategies remain elusive, highlighting the need for further research to improve outcomes for patients with this aggressive malignancy. [ABSTRACT FROM AUTHOR]

The nested subtype of urothelial carcinoma (NS-UC), a rare and aggressive bladder cancer, mimics benign bladder lesions but behaves like high-grade urothelial carcinomas. The author reported a rare case of NS-UC, initially presenting with inguinal lymph node metastasis. The tumor cells of NS-UC exhibit minimal cellular atypia, forming small nests, while the tumor cells of lymph node metastatic carcinoma show greater cellular atypia with diverse structures. Immunohistochemistry is helpful in determining the origin of lymph node metastatic carcinoma. NS-UC often presents morphologically similar to benign lesions, which should be given sufficient attention. [ABSTRACT FROM AUTHOR]

This case report highlights the successful application of a robotic-assisted surgical approach in managing Nutcracker syndrome. The patient, a 36-year-old female presented with severe symptoms and underwent robotic left renal vein transposition after failing conservative management. The procedure was performed through a minimally invasive approach utilizing the Da Vinci robotic system™ which offers enhanced visualization and precision. However, challenges arose during the renal vein anastomosis due to tension and poor flow through the transposition, requiring two revisions with a bovine pericardial patch. Ultimately, an 8 mm ringed PTFE bypass was anastomosed from the distal left renal vein to the Inferior Vena Cava. Despite these challenges, the patient experienced a successful outcome with complete symptom resolution of this complicated pathology. [ABSTRACT FROM AUTHOR]

Acute cholecystitis is a leading cause of individuals seeking medical attention in the emergency department due to right upper quadrant pain. Common complications associated with this clinical condition, which is frequently encountered in daily practice, include gangrenous cholecystitis, pericholecystic abscess, cholangitis, and gallbladder perforation. It is important to also consider the rare but potentially severe complication of cystic artery pseudoaneurysm. This case report details the development of a cystic artery pseudoaneurysm secondary to acute cholecystitis and its subsequent endovascular treatment in a 59-year-old male patient with no known underlying medical conditions, in accordance with existing literature. [ABSTRACT FROM AUTHOR]

Round ligament endometriosis is a rare phenomenon reported in approximately 0.3% to 0.6% of endometriosis cases. Presurgical diagnosis is carried out for about 50% of the cases. The association of the right-sided inguinal hernia, nonspecific pain in the organs, and no history of surgery or labor make the diagnosis intricate. We report a case of endometriosis of the round ligament in a 39-year-old woman who complained of intense pain in the right groin during the menstrual period for about 4 years, with no complaints of bulging or change in the size of the mentioned area. The clinical suspicion of inguinal endometriosis, supported by sonography and magnetic resonance imaging, was confirmed by histological examination of the surgical specimen after laparoscopic surgery, which included the mass and the extraperitoneal segment of the round ligament. After surgery, the patient's pain disappeared completely. The round ligament endometriosis or endometriosis of the inguinal region could be considered an important differential diagnosis in women of reproductive age without a history of surgery who presented with inguinal region pain during menstruation but no clear mass was palpable in the physical exam. [ABSTRACT FROM AUTHOR]

Background: Bilateral diaphragmatic dysfunction can lead to dyspnea and recurrent respiratory failure. In rare cases, it may result from high cervical spinal cord ischemia (SCI) due to anterior spinal artery syndrome (ASAS). We present a case of a patient experiencing persistent isolated diaphragmatic paralysis after SCI at level C3/C4 following thoracic endovascular aortic repair (TEVAR) for Kommerell's diverticulum. This is, to our knowledge, the first documented instance of a patient fully recovering from tetraplegia due to SCI while still exhibiting ongoing bilateral diaphragmatic paralysis. Case presentation: The patient, a 67-year-old male, presented to the Vascular Surgery Department for surgical treatment of symptomatic Kommerell's diverticulum in an aberrant right subclavian artery. After successful surgery in two stages, the patient presented with respiratory insufficiency and flaccid tetraparesis consistent with anterior spinal artery syndrome with maintained sensibility of all extremities. A computerized tomography scan (CT) revealed a high-grade origin stenosis of the left vertebral artery, which was treated by angioplasty and balloon-expandable stenting. Consecutively, the tetraparesis immediately resolved, but weaning remained unsuccessful requiring tracheostomy. Abdominal ultrasound revealed a residual bilateral diaphragmatic paralysis. A repeated magnetic resonance imaging (MRI) 14 days after vertebral artery angioplasty confirmed SCI at level C3/C4. The patient was transferred to a pulmonary clinic with weaning center for further recovery. Conclusions: This novel case highlights the need to consider diaphragmatic paralysis due to SCI as a cause of respiratory failure in patients following aortic surgery. Diaphragmatic paralysis may remain as an isolated residual in these patients. [ABSTRACT FROM AUTHOR]

Introduction: With current technology, ultrasound imaging in remote conditions, such as the International Space Station, is performed with vocal guidance or using a teleoperated echograph controlled by an expert. Both methods require real-time communications between the novice operator and expert to locate the probe over the appropriate acoustic windows (AW). The current study presents the development and testing of a new augmented reality software (Echo-QR) that would allow novice operators (with no medical imaging background) to correctly locate the ultrasound probe over the AW of interest without expert assistance. Methods: On the first day of the study, the positions of the probe over the AWs were identified for each organ by an expert sonographer and saved in the Echo-QR software. On the second day, the novices independently performed the ultrasound investigation using the Echo-QR software to correctly position the probe over each organ's AW. Results: Using the Echo-QR software, novice operators found the AWin 73 (92%) of the 79 organs. The 2D images acquired by the novices "2D direct image" were acceptable for medical evaluation in 41% of the cases. However, when the "2D direct image" did not show the entire organ, a 3D capture of the volume below the probe was also performed, which allowed for the extraction of the appropriate 2D image "2D/3D image" for medical evaluation in 85% of the cases. Discussion: Therefore, in the absence of real-time communication between an isolated participant and an expert sonographer, novel software (Echo-QR) and automated 3D volume capture can be used to obtain images usable for ultrasound diagnostics. [ABSTRACT FROM AUTHOR]

Enfortumab vedotin (EV) is a novel treatment option for patients with advanced/metastatic urothelial carcinoma who have progressed after chemotherapy and immunotherapy. Two patients at two different New England tertiary cancer care centers were treated with EV while concurrently receiving hemodialysis (HD), where a complete response to EV in both patients was noted. The use of EV in patients requiring HD is extrapolated from the available pharmacokinetic and pharmacodynamic literature on monoclonal antibodies in patients requiring HD. There is a paucity of data for the use of antibody-drug conjugates like EV in patients needing dialysis. [ABSTRACT FROM AUTHOR]

Simple Summary: This systematic review of the medical literature concerning the overlap between adnexal and gastrointestinal stromal tumors (GISTs) was designed to provide the overall number of previous observed cases and to calculate outcome prognosis, specifically the disease-free survival and overall survival. The impact of immunostaining and new chemotherapeutic medication such as Imatinib are also discussed. Background: Gastrointestinal stromal tumors (GISTs) are a rare neoplasm, sometimes mimicking primary ovarian tumors (OTs) and/or metastasizing to the ovaries (M-OT). We performed a systematic literature review (SLR) of OTs and M-OTs, investigating differences in recurrence-free and overall survival. Methods: Our SLR was performed according to PRISMA guidelines, searching in Pubmed, Scopus, and Web of Science databases from inception until 21 April 2024. Results: Overall, 59 OTs (Group 1) and 21 M-OTs (Group 2) were retrieved. The absence of residual disease after surgery was achieved significantly in a higher percentage of patients with Group 1 GISTs (91.5%) compared with Group 2 GISTs (57.1%). Chemotherapy was more frequently administered to Group 2 patients (33% vs. 0%). Recurrence and deaths for disease were significantly more frequent in Group 2 than Group 1 cases (54.5% vs. 6.8%, and 37.5% vs. 9.8%, respectively). Conclusions: GISTs can rarely mimic primary ovarian cancers or even more rarely metastasize to the ovaries. Group 1 GISTs occurred in younger women, were not associated with elevated tumor markers, and had a better prognosis. In contrast, Group 2 GISTs occurred in older women, may exhibit elevated tumor markers, and presented a worse prognosis. However, no significant statistical difference for survival between the two studied groups was detected. Computed tomography scans can define the size of GISTs, which correlate to stage and prognostic risk classes. The gold standard treatment is complete surgical resection, which was achieved in almost all cases of Group 1 GISTs and in half of Group 2. Histopathology and immunohistochemistry are essential for the final diagnosis and guide chemotherapy treatment. [ABSTRACT FROM AUTHOR]

Objective: Diamond–Blackfan anemia (DBA) is a rare and inherited form of erythroid aplasia, characterized by severe macrocytic anemia, congenital malformations, and predisposition to cancer. The purpose of this study is to determine the congenital abnormalities and dysmorphological features of DBA patients in a cross-sectional manner. Materials and Methods: The study group included patients who had diagnosis of DBA between 1983 and 2017. Dysmorphological examinations of the patients were performed by an experienced dysmorphologist and also echocardiography and abdominal ultrasonography were performed in order to figure out cardiac and urogenital abnormalities. Results: A total of 45 patients were examined in this study. Dysmorphological examination, echocardiography, and abdominal ultrasonography revealed the rate of congenital abnormalities as high as 88.7%. In consideration of the congenital abnormalities, the most common findings were craniofacial, followed by skeletal abnormalities. Conclusion: The rate of anomalies was found higher in our series of patients than that have been previously reported, most probably due to the evaluations being performed by a dysmorphologist in our cohort and not only depending on patient records or hematologists’ physical examination. [ABSTRACT FROM AUTHOR]

Regardless of the number of vessels involved endovascular recanalization of mesenteric vessels is the treatment of choice for chronic mesenteric ischemia. Reperfusion injury post-endovascular recanalization in chronic mesenteric ischemia is a rare clinical scenario as it is mostly encountered in cases of acute mesenteric ischemia. Here in, we describe a case with characteristic clinical and imaging findings of reperfusion syndrome, post-endovascular recanalization of chronically occluded superior mesenteric artery and severely stenosed celiac trunk in a patient with chronic mesenteric ischemia. [ABSTRACT FROM AUTHOR]

Laparoscopic cholecystectomy is among the most common surgeries in adults and is increasing in the pediatric age group. However, data are lacking on complications of the surgery and their treatment in children. Although many case series can be found that address hepatic artery injury after cholecystectomy in adults, we could not find similar publications in the English literature relating to the pediatric age group. This report shares the complex diagnosis and treatment process of a six-year-old female patient who presented with jaundice eight months after laparoscopic cholecystectomy. During the treatment process, it was observed that the common bile duct went into lysis in the late period due to haptic artery injury. The treatment continued with redo hepaticojejunostomy and catheters passed through the anastomosis line in the patient, who had anastomotic stenosis after hepaticojejunostomy. Twenty-four months after the patient's first operation, she had no active complaints. Complications may occur months after a cholecystectomy. In this case, arterial injury should be kept in mind. We wanted to contribute by presenting the first case in the literature on hepatic artery injury in the pediatric age group. [ABSTRACT FROM AUTHOR]

Transient neonatal diabetes mellitus (TNDM) is a genetically heterogeneous form of neonatal diabetes characterized by hyperglycemia that remits during infancy with a tendency to recur in later life. This case report presents the history of a male infant with transient neonatal diabetes mellitus. The patient was treated with a continuous subcutaneous insulin infusion (CSII) and a continuous glucose monitoring (CGM) system until the age of 2 months, when the normoglycemia connected with a withdrawal of treatment was noted. The genetic test results excluded the majority of known mutations related to TNDM. This case report focuses on various genetic mutations and the clinical features connected with them that cause TNDM and highlights the difficulties in the diagnostic and therapeutic processes of this disease. CSII and CGM systems seem to be a safe and effective treatment option in TNDM and may be used in the therapy. [ABSTRACT FROM AUTHOR]

Background: Encapsulating peritoneal sclerosis (EPS) or abdominal cocoon is a very rare cause of subacute intestinal obstruction. We hereby report an elderly male presenting with recent-onset subacute intestinal obstruction with characteristic imaging findings of this entity in a background of abdominal tuberculosis on computed tomography (CT) scan that enabled timely diagnosis and appropriate clinical management. The report aims to highlight the typical radiological findings of this rare entity that may otherwise go undetected on imaging investigations, thereby causing a delay in diagnosis with adverse clinical outcomes. Case presentation: A 57-year-old male patient presented to the hospital with complaints of diffuse abdominal pain with obstipation and recurrent episodes of vomiting since last three days. Clinical evaluation also revealed an ill-defined lump in right lower abdomen. An urgent contrast-enhanced CT scan after oral contrast administration was performed that revealed dilated, clumped up small bowel loops in a 'whorl-like' pattern in right iliac fossa region. These obstructed loops were encased by a thick peritoneal membrane giving a 'cocoon-like' appearance. Also appreciated were scattered punctate calcific foci in jejunal walls and adjacent peritoneum along with mild ascites. On the basis of typical imaging findings, provisional diagnosis of tubercular cocoon abdomen was given that was later confirmed by laboratory investigations and diagnostic laparoscopy. Conclusion: Encapsulating peritoneal sclerosis or cocoon abdomen is an extremely rare cause of subacute intestinal obstruction. Further, cocoon abdomen in a background of abdominal tuberculosis is even rarer. However, this case report highlights the characteristic imaging findings for broader audience that enabled prompt diagnosis and appropriate clinical management in this case, achieving optimal clinical outcome. [ABSTRACT FROM AUTHOR]

The article presents a case study of an 18-year-old female diagnosed with chronic myeloid leukemia (CML) who rapidly progressed to the blast phase despite treatment with tyrosine kinase inhibitors (TKIs). Topics discussed include the identification of recurrent fusion genes in CML-blast phase, their potential role in disease progression and drug resistance, and the need for further research to understand their prevalence and clinical implications.

The article presents the discussion on case study of 15-year-old male with an acute onset of abdominal pain in the epigastric region. Topics include differential diagnosis and a lipase level should be assessed when a patient presents with symptoms of acute pancreatitis; and patient did not report any trauma or co-ingestions including alcohol or tobacco.

Making a diagnosis of alcoholic liver disease is not always easy. There are problems in obtaining an accurate and reliable history of alcohol consumption. Laboratory findings and hepatic imaging studies are neither sensitive or specific, and newer test are being considered. Recently, a patient was admitted with possible alcoholic hepatitis. The first-year resident who admitted the patient mistakenly ordered a blood test for serum IgE. The result was a markedly elevated −6440 IU/mL. There was no evidence of parasitic infections, atopy or autoimmune disease nor was there any eosinophilia. A literature search showed that elevated IgE levels are associated with alcohol abuse. This association has been forgotten and does not appear in standard reference sources such as UptoDate or Harrison's Principles of Internal Medicine. This judicious use of examining serum IgE levels may aid in the diagnosis of alcoholic hepatitis. [ABSTRACT FROM AUTHOR]

Background: Crohn's disease is a chronic inflammatory bowel disease that can affect any part of the gut. Endoscopy is the gold standard for diagnosis, but it only assesses mucosal lesions. Magnetic resonance enterography (MRE) can assess disease presence and activity, but it has limitations such as motion sensitivity, long scan time, and high cost. Bowel sonography has been introduced as a non-invasive, practical, safe, and low-cost technique to assess disease activity and complications. In our study we aim to assess the comparability of ultrasound to MRE in evaluation of patients with Crohn's disease, and its complications. Results: Twenty-five patients with 38 Crohn's disease affected segments were evaluated by bowel ultrasound (BUS) and MRI enterography (MRE), where BUS and MRE showed equivalent diagnostic performance for disease detection and localization (97.4%, 100%), for sensitivity and specificity of both modalities. Peri-mural fluid (89.5%, 94.4%) and mural stratification loss (100%, 100%) showed high sensitivity and specificity by BUS compared to MRE, while for assessment of mural vascularity, BUS showed high sensitivity and specificity for high grade vascularity (100%, 83.3%), but low sensitivity and high specificity for low and moderate vascularity (0%–62.5%, 81.8%) compared to MRE. Complications including fistulae and abscessed were all correctly identified in BUS compared to MRE. Conclusion: BUS showed comparable results to MRE for identification, localization, assessment of findings related to disease activity, and complications in cases of Crohn's disease rendering it a viable alternative to MRE. [ABSTRACT FROM AUTHOR]

Background: Segmental hypoplasia of liver is an infrequently encountered congenital anomaly which is clinically indolent and detected incidentally on cross sectional imaging or abdominal surgery which can have a myriad of surgical and medical implications. The unique radiological manifestations and associated complications makes it a diagnostically challenging entity. Case presentation: We report a case of a middle-aged female presenting with complaints of non-specific abdominal pain for two years in which we reported the presence of segmental hypoplasia of right lobe complicated by development of portal hypertension incidentally detected on ultrasound examination which was followed up and confirmed on cross sectional imaging. Conclusions: In this case report, we present a unique instance of congenital segmental hypoplasia of the liver, highlighting the intricacies of its radiological presentation, potential clinical implications, and the challenges associated with its diagnosis. By examining this rare anomaly, we aim to contribute to the growing body of knowledge surrounding hepatic developmental disorders, fostering a deeper understanding of the clinical spectrum, and facilitating improved patient care through enhanced diagnostic awareness. [ABSTRACT FROM AUTHOR]

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Intracholecystic papillary neoplasm (ICPN) of the gallbladder is a relatively new concept and a rare neoplasm. ICPNs are found in 0.4% of cholecystectomies. ICPNs are commonly associated with low-to high-grade dysplasia and can be found with invasive foci. To the best of our research, <100 cases (n = 92) are reported worldwide and only 27 cases have been reported in India. We present a case of ICPN with a detailed review of the literature to illuminate the pitfalls of this entity, which is rarely encountered in routine reporting. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 36-year-old pregnant woman who was diagnosed with a large left renal mass at 17 weeks of gestation. Topics include the challenges and decisions involved in performing a radical nephrectomy; the successful surgical management of clear cell renal carcinoma and its subsequent impact on both maternal and fetal health; and the follow-up and surveillance for potential metastasis.

Aims This study sought to present a case report of a rare form of primary liver tumor known as fetal type Childhood hepatoblastoma, which belongs to the category of embryonal liver tumors. Patient & Methods This case report describes an eleven-year-old boy who experienced pain in the upper right quadrant of his abdomen after being hit by a bicycle handle during a fall while riding a bicycle. Subsequent imaging of the abdomen revealed the incidental diagnosis of a hepatoblastoma tumor. Prior to this incident, the patient was clinically asymptomatic. Findings Imaging examinations revealed the presence of a solid mass measuring 91 × 86 × 84 mm that originated in the right lobe of the liver. This mass exerted pressure on the renal cortex. Pathology analysis indicated that the mass was of the pure fetal epithelial subtype. Conclusion It is possible for older children to develop hepatoblastoma of the pure fetal epithelial type. [ABSTRACT FROM AUTHOR]

Synchronous occurrence of tumors in adrenal gland and pancreas is rare and is often considered as part of multiple endocrine neoplasia syndromes mainly VHL syndrome. Both pheochromocytomas and pancreatic NETs mostly occur sporadically and a small percentage are familial. We report a rare case of coexisting right adrenal interaortocaval pheochromocytoma and pancreatic neuroendocrine tumor in the absence of any familial syndrome in a 38-year-old gentleman. On evaluation for raised blood pressure, he was detected with abdominal lump on ultrasonography in December 2021. CECT abdomen showed a large well-circumscribed lobulated retroperitoneal mass epicentered in aortocaval groove compressing and displacing left renal vein with infrahepatic IVC thrombus suggestive of retroperitoneal sarcoma. Outside biopsy was suggestive of paraganglioma with raised 24-h urine metanephrines. Genetic workup with OncoPro hereditary cancer risk 98 gene panel revealed only VUS in POLD1 and PMS2 genes. DOTANOC scan showed a lobulated mass lesion 8 × 7.8 × 9.1 cm (SUVmax: 13.3) in retroperitoneal region and a SSTR expressing lesion of 1.8 × 1.5 cm (SUVmax: 52.7) in tail of pancreas not detectable on CECT scan. He was optimized preoperatively with alpha and beta blockers followed by excision of the interaortocaval mass and enucleation of the pancreatic tail NET with uneventful recovery. Histopathological examination showed right adrenal interaortocaval pheochromocytoma with pancreatic tail NET. This case shows that small neuroendocrine tumors may co-exist away from the primary site of pheochromocytoma in the absence of familial syndrome and may be missed on routine CT scan. Thus, further detailed investigation should be done to find and treat both lesions optimally in a multidisciplinary setting with surgery being the mainstay of treatment. [ABSTRACT FROM AUTHOR]

Background: The occurrence of ovarian hematoma during controlled ovarian stimulation (COS) is very rare. Until now, there is no such case reported in the literature. In this study, an attempt was made to discuss the possible mechanisms for the development of hematoma in such patients, the clinical presentation, monitoring, and management of these cases. Case Presentation: A rare case of periovarian hematoma was reported in a patient with a history of endometriosis undergoing ovarian stimulation for in vitro fertilization. On the seventh day of stimulation, the patient complained of severe pain in the abdomen. Her vitals and blood investigations were within normal limits. On abdominal examination, mild tenderness was noted in the left iliac fossa. On vaginal examination, fullness and tenderness were noted in the left fornix. On ultrasound, probe tenderness was present and a left ovarian hematoma measuring 2.0x1.81x1.55 cm was observed. She was managed conservatively. The hematoma exhibited a gradual reduction following the pick-up procedure and eventually resolved completely within a month. Conclusion: Underlying endometriosis could be one of the possible causes of this periovarian hematoma. A conservative approach with close monitoring forms the first-line management in hemodynamically stable patients. [ABSTRACT FROM AUTHOR]

Background: Trans-abdominal ultrasound (TAUS) and transvaginal ultrasound (TVUS) are used for embryo transfer. However, few studies were conducted to compare the methods and assess their effect on pregnancy outcomes. Methods: A retrospective cohort study was conducted at Mahdieh Hospital in Tehran, analyzing 506 ICSI cycles with fresh embryo transfer. The study period was from April 2019 to March 2022. Following the evaluation of patients’ profile, they were divided into two groups of TAUS (n=250) and TVUS (n=256). The pregnancy outcomes included positive test of β-HCG, history of miscarriage, ectopic pregnancy (EP), clinical pregnancy, and the duration of the embryo transfer were compared between two groups. Mann-Whitney U test, Pearson Chi-Square test, Fisher's exact test, and logistic regression were used for data analysis. Results: The rate of chemical and clinical pregnancy in the TAUS group was higher compared to the TVUS group, which was statistically significant (p<0.05). The rate of live term birth and live preterm birth was higher in the TAUS group compared to the TVUS group, though the difference was insignificant. Moreover, EP and abortion rates were higher in TVUS group compared to the TAUS group, but the differences were not statistically significant. The odds ratio of achieving pregnancy was higher with TAUS compared to TVUS, but this was only statistically significant for the age variable. Conclusion: The use of TAUS method appears to be associated with improved pregnancy outcome, including higher rates of chemical and clinical pregnancy, compared to TVUS. Yet, further research is needed to confirm these findings and elucidate underlying mechanisms. [ABSTRACT FROM AUTHOR]

Uterine perforation is a rare but potentially life-threatening complication of gynecologic procedures. Serious complications include hemorrhage, infection, and injury to surrounding organ systems (eg, gastrointestinal, urological, vascular, etc.). Risk factors include advanced maternal age, prior gynecologic surgeries, and other anatomical features that impact the difficulty of accessing the uterine cavity. In this case report, we discuss a patient who presented to the emergency department (ED) with diffuse abdominal pain and vaginal bleeding that occurred after an elective dilation and curettage (D&C) for a termination of pregnancy. The diagnosis was suspected clinically and confirmed by imaging including ultrasound (US) and computed tomography (CT) of the abdomen and pelvis. The patient was managed operatively with a multidisciplinary approach including Gynecology, General Surgery, and Urology. The patient was stabilized and eventually discharged. Uterine perforation should be included in the differential for patients with a history of recent gynecologic instrumentation presenting with abdominal pain and vaginal bleeding. The stabilization of these patients requires aggressive volume resuscitation, controlling the source of bleeding, and emergent surgical consultation. [ABSTRACT FROM AUTHOR]

Introduction: Hepatic dysfunction is a well-known complication and is frequently referred to as Fontan-associated liver disease. The aim of the study is to assess liver dysfunction in children and adolescents with Fontan circulation. Material and methods: The study was an observational analytical study conducted on 30 patients who underwent Fontan operation more than 2 years before inclusion in the study and who were followed up at the Paediatric Cardiology Unit, Cairo University Children's Hospital. All patients were subjected to echocardiography, laboratory investigations, abdominal ultrasound, and liver elastography. Results: The median patient age was 13 years (inter-quartile range [IQR] 10-16.32), and the median follow-up duration after the Fontan operation was 5 years (IQR 3.83-9). Global longitudinal strain was lower in 26 (86.7%), and the single ventricle ejection fraction was reduced in 23 (76.7%); however, no correlation was found with time interval since Fontan. None of the patients had ascites clinically or by ultrasound examination. Gamma-glutamyl transferase was elevated in 28 (93.33%), which was significantly higher in the systemic right ventricle group. Abdominal ultrasound revealed periportal enhancement in 6 (20%), which was significantly higher in the hepatitis C virus exposed group (p = 0.006). Superior mesenteric artery resistance index was decreased in 27 (90%), which was significantly lower in the systemic left ventricle group (p = 0.01). The liver stiffness values did not correlate with time interval since Fontan (p = 0.09). Conclusions: Liver disease is prevalent in Fontan patients. Non-invasive measures such as laboratory tests, ultrasound, and elastography should be implemented with consideration for hepatology consultation. Fontan-associated liver disease screening is important in the monitoring of Fontan patients. [ABSTRACT FROM AUTHOR]

Background: Bariatric surgery has been widely distributed as an effective treatment method for morbid obesity. An increased volume of the left hepatic lobe may affect the ergonomics of bariatric surgery, which could complicate the surgical techniques and require special instruments. CT of the abdomen is considered the gold standard imaging modality in the assessment of the left hepatic lobe volume; nevertheless, it has some drawbacks, such as exposure to ionizing radiation, besides the contrast and gantry limitations. The objective of this study is to investigate the diagnostic accuracy of abdominal US in comparison to CT in measuring the left hepatic lobe volume in morbidly obese patients as part of their preoperative evaluation. Seventy-two morbidly obese patients of different ages (between 22 and 55 years) and genders were included in this study who were scheduled for bariatric surgery. Results: The intraclass coefficient and Cronbach's alpha reliability coefficient with their 95% CI were used. There was a strong positive correlation between left hepatic lobe volumes as measured by US and CT (r = 0.999, p value < 0.001), indicating a significant linear relationship between them. The mean of the two variables was very close (474.2 ± 164.9 cm3) by US and (475.1 ± 164.5 cm3) by CT. Conclusions: Abdominal US examination for assessment of the left hepatic lobe volume is considered a valid diagnostic method compared to CT (with a clinically accepted slight difference between values) in preoperative assessment of morbidly obese patients. It provides an accurate, simple, and inexpensive diagnostic tool that avoids the drawbacks of CT. [ABSTRACT FROM AUTHOR]

The article discusses a 15-year-old female with Graves' disease who developed acute liver injury secondary to autoimmune hepatitis (AIH) after initiating methimazole treatment, highlighting diagnostic and therapeutic challenges in managing coexisting autoimmune conditions. Topics include diagnostic dilemma posed by elevated transaminases in Graves' disease patients, the importance of comprehensive hepatitis workup, and the therapeutic approach to managing AIH alongside hyperthyroidism.

This study aimed to explore and compare the effect of weight change, and waist circumference (WC) change, on the risk of nonalcoholic fatty liver disease (NAFLD) in individuals with metabolically healthy overweight or obesity (MHOW/O) and metabolically unhealthy overweight or obesity (MUOW/O) in a health check-up cohort in China. 5625 adults with overweight or obesity, and free from NAFLD at baseline were included. Metabolically healthy was defined as not having any components of metabolic syndrome. Weight/WC changes were calculated as the relative difference between the first and second visits of check-up. NAFLD was assessed based on abdominal ultrasound. During a median follow-up of 2.1 (IQR: 1.1–4.3) years, 1849 participants developed NAFLD. In MHOW/O participants, the multivariable adjusted HRs (95 % CIs) for NAFLD in weight change ≤ −5.0 %, and − 4.9–− 1.0 % were 0.36 (0.23–0.59), 0.59 (0.43–0.80), respectively, compared to the weight stable group (−0.9% to 0.9 %). The corresponding HRs (95 % CIs) for the association between WC change (≤ 6.0 %, - 5.9 to −3.0 %) and NAFLD in MHOW/O participants were 0.41 (0.27–0.62), and 0.74 (0.54–1.01), respectively, compared to the WC stable group (−2.9–2.9 %). Similar patterns were observed in MUOW/O participants. A more marked gradient of cumulative incidence of NAFLD across weight/WC change categories was observed in MHOW/O than in MUOW/O individuals. A more evident association between weight/WC loss and risk of NAFLD was observed in MHOW/O than in MUOW/O individuals. Our findings indicate the practical significance of encouraging all individuals with overweight and obesity to achieve a clinically relevant level of weight/WC loss to prevent NAFLD, even among metabolic healthy groups. [ABSTRACT FROM AUTHOR]

Acromegaly is a rare condition characterized by increased secretion of growth hormone (GH) and insulin-like growth factor 1 (IGF-1). This disease may predispose to the development of neoplasms. This study aims to present a case of a patient with acromegaly and coexisting pancreatic adenocarcinoma and to highlight the potential positive impact of somatostatin receptor ligands used in acromegaly treatment on the potential benefits when combined with conventional pancreatic adenocarcinoma therapy. [ABSTRACT FROM AUTHOR]

Introduction: Hepatic portal venous gas is a rare and life-threatening condition characterised by the presence of gas in the portal vein. Hepatic portal venous gas is frequently associated with intestinal ischaemia and necrosis. We present the case of a paediatric patient with acute appendicitis with hepatic portal venous gas detected using ultrasonography. Case report: A 5-year-old boy was admitted to our hospital with a respiratory tract infection. The boy started vomiting on day 2 of hospitalisation. He did not complain of any symptoms due to developmental retardation. We performed bedside point-of-care ultrasound, which detected hepatic portal venous gas, although the appendix could not be detected due to an acoustic shadow associated with bowel gas. Contrast-enhanced computed tomography revealed perforated appendicitis and pneumatosis intestinalis associated with paralytic ileus. An emergency laparoscopic appendectomy was performed. He was discharged on day 25 of hospitalisation after antibiotic therapy. Discussion: The present case suggests that the mechanism of hepatic portal venous gas was paralytic ileus, which caused gas-forming bacterial proliferation. The gas produced by bacteria and/or the gas-forming bacteria entered the bowel wall, which caused pneumatosis intestinalis. The bubbles in the intestinal wall floated in the portal system and were detected as hepatic portal venous gas. Perforated appendicitis and paralytic ileus seemed to be caused by a delayed diagnosis of appendicitis. The point-of-care ultrasound examination was useful for detecting hepatic portal venous gas and for helping establish the diagnosis of appendicitis. Conclusion: Hepatic portal venous gas is a rare finding associated with appendicitis in children. In addition, point-of-care ultrasound is useful for detecting hepatic portal venous gas in paediatric patients. [ABSTRACT FROM AUTHOR]

Gallstone ileus is a rare complication of cholelithiasis, predominantly affecting older women and carrying a risk of high mortality and morbidity rates. While Rigler's triad radiologic features can aid in diagnosis, they are only present in a portion of patients. Surgery is a primary method for symptom relief, but discussions persist about the most suitable surgical strategy. This report details a case of gallstone ileus causing jejunal obstruction, successfully treated with laparoscopic-assisted enterolithotomy. [ABSTRACT FROM AUTHOR]