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Sacrococcygeal teratomas (SCT) are known to originate from pluripotent cells and are among the most common perinatal germ cell tumours with an incidence of 1:30000- 1:40000. Primary treatment is surgical resection. Here we present a case of a term 3.38kg female baby delivered via normal vaginal delivery who presented with a large cystic lesion 10x15cm in size distal to the coccyx. The neonate was posted for surgery on day 2 of life. The procedure was done in lithotomy position and exceeded 4 hours duration. One episode of intra operative hypotension was noted for which IV dopamine infusion was started at 10mcg/kg/minute. Through-out the procedure the body temperature was maintained with body warmer and fluid warmers in place. Blood loss exceeded the maximum allowable blood loss of 100ml which was replaced by packed red blood cells administered at 15ml/kg to a total of 55ml. The baby was shifted to the NICU with endotracheal tube insitu for further management in the postoperative period. Hyperkalemia was noted and corrected in the NICU. The baby was extubated on post-operative day 3 and discharged on day 5 after surgery. Resection of large Sacrococcygeal teratomas can be challenging and requires meticulous planning, vigilance, and a multidisciplinary team approach.

Introduction: Emphysematous pyelonephritis is a rare, acute, and life-threatening necrotizing renal infection caused by gas-producing facultative anaerobes, such as Escherichia coli, Klebsiella, and Proteus, most commonly in the setting of underlying diabetes mellitus. Pneumomediastinum is a rare imaging finding in this disease, and a high index of suspicion is required for diagnosing emphysematous pyelonephritis in patients presenting with pneumomediastinum, in the right clinical setting. Case presentation: We present the case of a middle-aged female patient with symptoms and laboratory findings indicating infection, renal failure, and hyperglycemia, and a personal history of diabetes mellitus. The imaging procedures revealed findings of a severe and advanced necrotizing renal infection with parenchymal destruction and intraparenchymal gas collections extending into the perirenal and pararenal spaces. We established the diagnosis of emphysematous pyelonephritis accompanied by perirenal abscess formation and pneumoretroperitoneum, with gas collections propagating into the mediastinum. In the setting of such a severe form of infection, the patient underwent immediate surgery with left nephrectomy. Despite prompt and intensive treatment, the patient unfortunately succumbed to the disease during the postoperative period. Conclusion: Pneumomediastinum is a rare complication of retroperitoneal processes, and, when present, indicates their extensiveness, often being an ominous prognostic sign. By presenting this case, we aim to highlight the severity of this form of renal infection and the unequivocal need for immediate response, as well as to emphasize the significance of imaging findings, which are somewhat unusual, but should raise suspicion of an insidious and serious retroperitoneal infection.

Introduction. Trichobezoars presents a rare form of bezoar made of swallowed hair, with clinical manifestation of gastric or intestinal obstruction, gastric ulceration, bleeding, and perforation. It is predominantly found in emotionally disturbed or mentally retarded youngsters, who eating their own hair which is clinically known as trichophagia. Patients often deny eating their own hair which makes diagnosis difficult. Case report. We present a case of acute gastric outlet obstruction caused by a giant gastric trichobezoar made of a long thin hair, in a 20-year young female. Although patient had a long history of trichophagia, she did not think her behavior was unusual and she had not been treated before. Following the initial diagnostic procedures, exploratory laparotomy was indicated. After anterior gastrotomy was performed, a massive stomach-shaped trichobezoar was removed. Postoperatively, the patient had a psychiatric consult exam. She recovered well and was discharged without complications. She was referred for further psychiatric follow-up. Conclusion. Trichobezoars are non-digestible collections that usually accumulates in stomach and can extend to small bowel, causing mechanical injury such as hollow viscus obstruction. Patients with acute gastric obstruction caused by a giant trichobezoar require urgent removal of the trichobezoar, to preserve the stomach and avoid further, catastrophic consequences.

Background Low grade fibromyxoid sarcoma (LGFMS) is a rare and benign mesenchymal tumor with indolent course, most commonly found in young or middle-aged men. The majority of the LGFMSs are located in the trunk and deep soft tissue of the lower extremities. They appear as well circumscribed, although not encapsulated, which often leads to incomplete surgical resection. Despite their seemingly benign appearance, these tumors have aggressive behavior with high metastatic and recurrence rates. Accurate histopathologic examination of the specimen and its immunohistochemical analysis are mandatory for a precise diagnosis. Case summary We report a case of a 38 year-old-man who presented with jaundice and upper abdominal discomfort. Multi-detector computed tomography and magnetic resonance imaging showed a large left liver tumor mass, extending to the hepatoduodenal ligament. Left hepatectomy was performed with resection and reconstruction of hepatic artery and preservation of middle hepatic vein. Histopathologic examination confirmed the tumor being a low-grade fibromyxoid sarcoma. Three and a half years after surgery, the patient died after being diagnosed with spine metastasis. Conclusion Due to poor response to all modalities of adjuvant treatment, we consider that the focus of treatment should be on surgery as the only option for curing the disease.

Clearly defined protocols and multidisciplinary approach present a milestone for patients' condition evaluation. Ultrasound is a fast, accessible, non-invasive and repeatable radiological examination and has an important place in the trauma algorithms. It detects trauma of parenchymal and hollow abdominal organs, hematoperitoneum, and helps in the assessment of volume status. Ultrasound in trauma is performed according to the Focused Assessment with Sonography for the Trauma (FAST) protocol or as a standard ultrasonographic examination of the abdomen and can be repeated to monitor morphological changes due to indications for emergency surgical treatment.

Ultrasound is an essential and often initial visualization diagnostic procedure in all algorithms for urgent care of acute abdominal conditions. Ultrasound is a fast, accessible, non-invasive diagnostic examination method that does not involve ionizing radiation and can be repeated. It is vital in detecting free fluid in the abdominal cavity, acute pathological conditions of parenchymal and hollow organs, and assessing volemic status. Ultrasound efficiently and accurately diagnoses acute pathological conditions of the hepatobiliary and urogenital system. It certainly makes a significant contribution to the definitive diagnosis of pathological conditions of the gastrointestinal and vascular systems and can help detect pneumoperitoneum as an indication for urgent surgical treatment.

Introduction: Biliary ileus is a rare emergency condition that mainly affects the elderly population, with a predominance of females and a mortality rate of 12-27%. It is a mechanical intestinal obstruction caused by the impaction of the biliary calculus within the gastrointestinal tract. It occurs due to the formation of bilio-enteric fistula, as a rare complication of cholelithiasis. Case report: A 73-year-old male patient with epigastric pain, nausea and vomiting was referred for ultrasound exam. The analysis of the clinical-biochemical status of the patient as well as the ultrasound examination of the abdomen itself raised the suspicion of small intestine obstruction, due to the enclaved biliary calculus. After an urgent exploratory laparotomy, the diagnosis was confirmed, and enterotomy was successfully performed with calculus extraction. Cholecysto-duodenal fistula has been confirmed as a major cause of biliary ileus. The post-operative course was uneventful. Conclusion: This case report highlights the enormous importance of ultrasound diagnostics in diagnosing biliary ileus using the criteria of The Rigler Triad, which includes pneumobilia, intestinal obstruction and ectopic calculus. Initially unrecognised cause of obstruction and a late diagnosis correlated with bad prognosis. Ultrasonographic examination of these patients can be a sufficient diagnostic modality in making an accurate diagnosis and further surgical treatment of these patients

The importance of ultrasound diagnostics in intensive care units is based on the fact that it is a radiological examination method that does not involve the use of ionizing radiation, can be repeated several times in a short period of time, minimally invasive, simple to carry out, does not involve transporting the patient to the radiology service and enables immediate decision-making on diagnosis and further treatment of the patient. Bedside lung US (bLUS) can reliably identify pneumothorax, consolidation, atelectasis, interstitial syndromes, pleural effusions with a high degree of sensitivity. Experts consider it a reliable tool on the basis of which a clinical decision can be made. Chest radiography is the most commonly used visualization method of examination in intensive care units and is certainly used for the diagnosis of ARDS. Radiography cannot monitor changes in the interstitium in a short period of time but ultrasound can detect more discrete changes in the interstitium, which is important for making the decision to extubate the patient. Bedside lung ultrasound is a simple visualization technique for the detection and characterization of conditions in the lung parenchyma. It can detect pleural effusion, interstitial syndrome, pneumothorax with considerable sensitivity and can be a good prognostic criterion for patient extubation

COVID - 19 is a 21st-century pandemic. Coronavirus 2 (SARS-CoV-2) causes coronavirus disease - COVID-19 (Corona Virus Disease-19), zoonose. The virus was previously known as the 2019 novel coronavirus. A non-specific and most common clinical and radiological finding is pneumonia, which was called novel coronavirus-infected pneumonia (NCIP) duo to its previous virus name. Pneumonia is bilateral, peripheral localization, and basal distribution. So far, there is no specific treatment or vaccine to prevent COVID-19; all measures consist of supportive therapy. The clinical presentation varies in severity from asymptomatic to mild form of the disease, over severe forms to fatal outcomes. Depending on the stage of COVID-19, the findings obtained using radiological methods also depend. About half of the patients have a normal CT scan within the first two days of the onset of the disease. However, the occurrence of pathological findings reaches its maximum between days 9 and 13. At first, the zones of "ground glass" opacification are present, followed by the discovery of "crazy paving" , and then the development of consolidation. With the improvement of the disease, fibrosis zones occur, and the changes recede one month and beyond. Echosonography has an important place in the monitoring and management of severe patients in intensive care units, and especially in lung conditions.

Introduction. Isolated jejunal perforation (IJP) without any associated injuries is rare in blunt abdominal trauma (BAT). It most commonly occurs in decelerating trauma. Diagnosis of traumatic intestinal perforation may be difficult in the first hours after injury so unrecognized ?missing? intestinal injuries incidences are as high as 24%. Unrecognized traumatic bowel perforation without adequate treatment leads to the intestinal leakage into the peritoneal cavity, leading to secondary peritonitis and potentially lethal complications. Case outline. We presented the case of a 43-year-old woman injured in a road traffic accident. She was admitted to emergency surgery after diagnostic procedures according to the protocol for trauma. Initial examination, and body computed tomography (CT) revealed orthopedic injuries. Daily monitoring and follow-up examinations were done, she did not complain of any discomfort nor pain in the abdomen, and there were no signs of abdominal injury. Two days after trauma, follow-up abdominal CT revealed highly suspected jejunum perforation, still without signs of pneumoperitoneum. Laparotomy was performed and diagnosis of IJP was confirmed. Bowel perforation was surgically closed in two layers, followed by drainage of septic collections, abdominal saline lavage and primary abdominal closure. The patient was discharged on the seventh postoperative day without complications. Conclusion. In the case of BAT due to severe traumatic force in patient with nonspecific clinical signs of abdominal trauma on initial clinical and radiological examination, follow-up in a short period is necessary, to detect hidden jejunal perforation. Surgery is a life-saving for those patients and treatment of these injuries usually require simple operative procedures.

Introduction. Duodenal hematomas are commonly traumatic, caused by blunt abdominal trauma. Nontraumatic spontaneous intramural hematomas of the duodenum are rare, and in most cases induced by anticoagulant therapy. The diagnosis is based on clinical and biochemical parameters, endoscopy, and radiological examinations. The objective of this report was to present a clinical and radiological presentation of an intramural duodenal hematoma caused by anticoagulant therapy. Case outline. A 43-year-old female was presented with epigastric pain, nausea, hematemesis, and melena. She had a positive medical history of deep venous thrombosis of the pelvis, which was diagnosed the previous month, for which she received oral anticoagulant therapy (coumarin). Physical examination revealed diffuse abdominal tenderness, while laboratory analyses showed markedly elevated international normalized ratio (INR) of prothrombin time (INR > 7), which indicated the anticoagulant intoxication. Computed tomography (CT) showed luminal narrowing with uniform circumferential wall thickening of the descendent and horizontal part of duodenum, which was hyper dense in the native series and slight and uniform ring-formed enhancement in post-contrast phases, a typical CT presentation of intramural duodenal hematoma. Periduodenal and right sided pararenal hematomas were also visualized. After stopping the anticoagulant therapy and performing conservative treatment (vitamin K) with good therapeutic effect being monitored by physical examination, laboratory analyses and transabdominal ultrasonography, spontaneous resolution of the duodenal hematoma was revealed by follow-up CT examination two weeks after the onset. Conclusion. Ultrasonography and CT are useful diagnostic tools in recognition of the intramural duodenal hematoma and other locations of hemorrhage and in monitoring therapeutic effects.

Accessory liver lobes (ALL) are defined as supranumerary liver lobes, composed of normal liver parenchyma in continuity with the liver, in contrast to ectopic liver lobes (ELL) that have no anatomical continuity with the normal liver. Case report: In this article we report on a rare radiological diagnosis of an synchronous accessory and ectopic liver lobe using ultrasonography (US) and computed tomography (CT). A 59-year-old female with no symptoms was admitted to our hospital due to preventive exam. Abdominal ultrasonography revealed a high echoic 6 cm x 5 cm soft tissue area in right anterior subhepatic space with distinct margins, a uniform echo and blood flow and was suspected to be abdominal tumor. An enhanced abdominal computed tomography (CT) showed the irregular 65 mm x 48 mm x 32 mm mass in the right hypochondrium below IV and V liver segment with clear margins, a uniform density, texture and contrast enhancement as normal liver tissue. In same patient CT also showed small 16 mm x 12 mm mass in posterior mediastinum in right retrocrural space so diagnosis of accessory and ectopic liver lobe was confirmed. An accessory liver lobe is adjacent and attached to the liver by its own mesentery, while an ectopic liver lobe is one that is completely detached from the normal liver parenchyma. Conclusion: Ultrasound can show mass in the abdomen, which is most commonly in the subhepatic area, but very rarely can initially diagnose ALL or ELL due to different echogenicity of the liver parenchyma in different acoustic windows. In the case of an atypical CT presentation, an MR examination of the abdomen is indicated but it is very rarely. Fast and accurate radiological diagnosis of ALL and ELL is important in the prevention of unnecessary invasive diagnostic procedures such as laparotomy and thoracotomy which are needed only in cases of complications.

Background Intrahepatic mass-forming cholangiocellular carcinoma (IMC) is the second most common primary liver tumor. The differentiation between IMC and solitary hypovascular liver metastases (SHLM) represents a diagnostic challenge due to many overlapping magnetic resonance imaging (MRI) features. Purpose To determine the value of diffusion-weighted imaging (DWI) in addition to conventional MRI for the distinction between intrahepatic mass-forming cholangiocarcinoma and solitary hypovascular liver metastases. Material and Methods Fifty-three patients with pathologically proven IMC (n = 31) and SHLM (n = 22) who had undergone MRI and DWI before surgery or percutaneous biopsy were enrolled in this study. The following MRI features were analyzed: the size and shape of the lesion, presence of capsular retraction and segmental biliary dilatation, T2-weighted (T2W) signal intensity, the presence of target sign on DWI and enhancement pattern. Apparent diffusion coefficient (ADC) values were calculated for each lesion ( b = 800 s/mm2). Univariate and multivariate logistic regression analyses were used to identify significant differentiating features between IMCs and SHLMs. Results Univariate analysis revealed that following parameters favor diagnosis of IMCs over SHLMs: lobulating shape, heterogeneous T2W signal intensity, capsular retraction, segmental biliary dilatation, target sign on DWI and rim-like enhancement on arterial phase followed by progressive enhancement in delayed phases. ADC values measured in the periphery of the lesion were significantly lower in IMCs in comparison to SHLMs. Multivariate analysis revealed that target sign on DWI was the most significant predictor of IMCs. Conclusion Qualitative DWI analysis with target sign significantly improves diagnostic accuracy for differentiation among IMC and SHLM lesions.

Blunt abdominal aortic injuries are extremely rare, diagnosed in less than 0.05% of all trauma admissions. Aortic injury caused by a seat belt during a car accident is often referred as "seat-belt aorta". We present a case of an 18-year-old woman, restrained back passenger involved in a vehicular collision, sustaining vertebral column and multiple rib fractures, mesenterium and colonic injury, and infrarenal aortic contusion with localized dissection and partial thrombosis.