An unprecedented large mesonephric cyst posing diagnostic dilemma and surgical challenge

Mesonephric cyst is a vestigial remnant of the Wolffian duct in females. Occasionally, the mesonephric duct persists lateral to the vagina and uterus, and cystic lesions may sometimes develop into neoplastic lesions. Mesonephric cysts are very rare. Here we report an unprecedented large left broad ligament mesonephric cyst in a 27 year old lady that posed diagnostic and surgical challenges. Ultrasound findings included cystic swelling probably arising from left ovary suggestive of left ovarian cyst. Plain abdominal computed tomography scan showed large simple left paraovarian cystic mass with no solid areas. During laparotomy, we found a large left thin walled cyst with smooth external surface with vascular prominence measuring 20x13x11 cm arising within the broad ligament stretching the left Fallopian tube, close to left ovary and adherent to recto-sigmoid. Cystectomy was done with preservation of left ovary. Histopathology report was consistent with mesonephric cyst. Mesonephric duct cyst should be considered in the diagnosis of abdomino-pelvic masses in females of adolescent and early reproductive age

Comparison of Ultrasound-Guided Umbilical Venous Catheter Insertion with Blind Method: A Randomized Controlled Trial

Introduction: Ultrasonography (USG) can be used in neonates to manipulate and place the umbilical catheter in the correct position. Although chest radiograph (CXR) is the gold standard, a noninvasive method like USG without radiation exposure may be an alternative bedside armamentarium to the clinician. The purpose of the study was to evaluate whether USG-guided umbilical venous catheter (UVC) insertion is superior to the conventional method for the successful insertion of UVC. Method: The neonates born between 25 and 42 weeks of gestation requiring parenteral fluids and admission to neonatal intensive care unit (NICU) between September 2020 and November 2022 were randomized in two weight-based strata: ≤1,200 and >1,200 g. USG-guided UVC insertion was done in the intervention group and blind UVC insertion was done in the control group. Results: Out of 112 enrolled neonates, 58 were in the USG-guided group and 54 in the blind group. There was no significant difference in the failure rate between the intervention and control groups (20% versus 29% [RR: 0.69, 95% CI: 0.36–1.33]). The sensitivity and specificity of USG in locating tip position were 97 and 46.8%, respectively. The mean procedure time in USG and blind groups was 8.9 and 8.3 min, respectively (p value 0.56). Conclusion: USG does not reduce the failure rates during the insertion of umbilical catheters. However, being a safe, noninvasive procedure, it can be considered a rescue modality to CXR in NICUs equipped with portable USG for guiding UVC insertion

Ectopic Posterior Pituitary and Its Associations with Extrapituitary Intracranial Anomalies

Posterior pituitary ectopia is a very rare entity in the development of the pituitary gland. Several factors and multiple genes are associated with this entity causing both pituitary and extrapituitary abnormalities. Pituitary abnormalities can be various endocrine problems and extrapituitary abnormalities can be optic nerves and cerebellar hypoplasia, heterotopia, and abnormal vessels. This pictorial review represents the imaging manifestations of extrapituitary intracranial anomalies that can be associated with posterior pituitary ectopia

Diffusion-Weighted Imaging and Chemical Shift Imaging to Differentiate Benign and Malignant Vertebral Lesion: A Hospital-Based Cross-Sectional Study

Objective The aim of this study was to evaluate the role of diffusion-weighted imaging (DWI) and chemical shift imaging (CSI) for the differentiation of benign and malignant vertebral lesions