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Epidermoid cyst in the oral cavity is uncommon. It is even more rare to see an epidermoid cyst in the sublingual region. We report the case of a 30-year-old male presenting with a swelling in the floor of the mouth extending into the submental and submandibular regions. The midline swelling was painless, soft, and dome-shaped. CT scan contrast revealed the site and extent of swelling. The complete surgical excision of the lesion was performed via a transcervical approach. Histopathology revealed cystic fibrocollagenous tissue covered by squamous epithelium containing some keratin flakes.
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Background and objectives The high cost of video-assisted transthoracic procedures precludes their use in the diagnostics of mediastinal masses in low- and middle-income countries (LMICs). This study aims to assess the technical success rate and diagnostic yield of ultrasound-guided transthoracic mediastinal biopsies at a tertiary care hospital. Methods This descriptive cross-sectional study was conducted in patients presenting with mediastinal masses referred to radiology services at Dr. Ziauddin University Hospital. Karachi, Pakistan. Ultrasonography was performed using Toshiba Xario 200 & Aplio 500 using convex and linear probes accordingly. Biopsy was performed using a combination of 18G semiautomatic trucut and 17G co-axial needles. Complications and overall diagnostic yields were determined. Results In all 70 patients referred, the procedure was completed successfully with an overall procedural yield of 95.7%. Inconclusive biopsies due to inadequate specimen were seen in two (4.2%) patients. No post-procedure major complication or mortality was observed. Minor complications were seen in three (4.2%) out of 70, including hematoma (<3 cm) in one patient and small pneumomediastinum in two patients. Conclusion Ultrasound-guided transthoracic mediastinal biopsy may be the pragmatic technique of choice in LMICs for the diagnosis of mediastinal masses as they provide real-time visualization and is cost-effective and safe.
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Introduction Lung cancer is the most common cancer overall, and the foremost cause of cancer-related mortality. Almost all lung cancers evolve from pulmonary nodules. As multidetector CT (MDCT) scanners are now widely available, there is an increased rate of detection of pulmonary nodules. It is of utmost importance to evaluate pulmonary nodules to rule out the possibility of neoplastic diseases. With advancements in technology, there are various manual and automatic analytic software providing a wide range of post-processing techniques. Maximum intensity projection (MIP) and volume rendering (VR) techniques have been analyzed previously regarding pulmonary nodules but there is a scarcity of data in terms of low-density nodules. This study aims to delineate the comparison and supremacy of both techniques in terms of low-density nodules. Methodology The current prospective study was conducted from June 2019 to June 2020 in the Radiology Department at Dr. Ziauddin Hospital, Karachi. Chest CT scans were performed on 16 slice MDCT (Alexion 16 Multi-slice, Toshiba Medical System Corporation, Houston, TX). A consultant radiologist of six years experience and a postgraduate trainee of three years experience analyzed each patient on a workstation (Vitrea 6.2.0, Vital Images, Minnetonka, MN). SPSS 23.0 (SPSS Inc., Chicago, IL) was incorporated for data analysis. Data were expressed in the median and interquartile range (IQR). Data collected for this study were analyzed using analyzing the median difference in nodule count using Wilcoxon's signed-rank test. A p-value of <0.05 was considered significant. Results After informed consent, 236 patients were recruited for the study. MIP outperformed VR in terms of nodule detection and low-density nodules at each evaluated slab thicknesses (p<0.001). A 10-mm MIP was superior to all other techniques in terms of detection of pulmonary nodules and low-density nodules (p<0.001). MIP was also considered an easier technique as there was excellent inter-rater reliability and agreement. Conclusion This study is robust evidence regarding the supremacy of MIP. MIP outperformed VR on every slab thicknesses. The 10-mm MIP technique was superior to all others evaluated and was recorded to be an easier analyzing technique.
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Introduction Hepatobiliary tree variant anatomy is crucial to understand the preoperative planning of hepatobiliary surgeries. Although the presence of variant anatomy is not an absolute contraindication for liver transplantation, inadvertent mapping can lead to postoperative biliary complications. These variants are also important to be recognized in various hepatobiliary surgeries and interventional procedures. Magnetic resonance cholangiopancreatography (MRCP) is an excellent non-invasive imaging tool that can identify biliary anatomy. The purpose of the current study is focused on determining anatomical variants of the biliary tree on MRCP in our population visiting a teaching hospital in Karachi. Methods This cross-sectional study was conducted on patients referred to Dr. Ziauddin Hospital for MRCP. MRCP was performed on MAGNETOM Avanto, SIEMENS, Belgium, Germany. Images were analyzed on a workstation by two radiologists and a postgraduate trainee. A senior radiologist reviewed equivocal cases. SPSS 22.0 (SPSS Inc., Chicago, IL) was used for statistical analysis. Chi-square test was used to see the link between anatomical variants of biliary tree and gender. P-value of ≤0.05 was considered as statistically significant. Results We recruited 369 patients undergoing MRCP consecutively for our study. Out of 369, 342 patients were eligible for analysis (139 males and 203 females). Standard anatomy was found to be prevalent in 65.8%. Type 3 was the leading variant. A statistically significant difference was recorded for the type 2 anatomic variant which was more frequent in males than females (p-value <0.001), while types 1, 3, and 4 anatomic variants were found to be more in females than males but this difference was not statistically significant. Few other variants were also recorded. Conclusion This study is robust evidence regarding biliary variants in Pakistan. It is important to consider these variants in our region, owing to an increased trend of liver transplants and other hepatobiliary procedures.
