Congenital cervical teratomas are rare tumours arising from the neck and consist of three major tissue layers of an embryo: the ectoderm, endoderm, and mesoderm. A great majority of cervical teratomas are benign tumours. However, the clinical significance of these tumours arises from the complications they can cause during pregnancy due to the postnatal mass effect on the airway and oesophagus of the neonate. Diagnosis of a congenital cervical teratoma is possible during an early prenatal ultrasound evaluation. The appearance depends on the size of the tumour, but it is typically a large neck mass with solid and cystic components that causes hyperextension of the neck and is frequently associated with polyhydramnios. In the postnatal period, ultrasound helps in differentiating cervical teratoma from other common congenital cervical masses. MRI is the modality of choice to evaluate the consistency of the tumour, surrounding soft tissue extent of the tumour, and any mass effect on other cervical structures. In our case report, we present a case of a full-term baby that was delivered with a large cervical mass. MRI was helpful in demonstrating the complex content of the mass, surrounding soft tissue extension, and mass effect on other major cervical structures. The clear demarcation of the mass facilitated complete surgical removal without complications.

4. Laryngoscope, 126:2804-2810, 2016.

Esophageal lung is a rare communicating bronchopulmonary foregut malformation in which the main bronchus arising from the trachea is absent. The affected lung is usually hypoplastic and aerated via an anomalous airway originating from the esophagus. Other anomalies such as esophageal atresia with tracheoesophageal fistula or VACTERL (vertebral defects, anal atresia, cardiac defects, tracheoesophageal fistula, renal anomalies, and limb abnormalities) association can co-exist. The initial radiographic findings may be normal, but subsequent imaging usually shows progressive and recurrent lung collapse, probably because of recurrent aspiration through the anomalous airway and poor compliance of the affected lung during breathing. In this report, we describe a neonate with esophageal lung and rare associated anomalies, including anorectal malformation, pulmonary artery sling, and inferior vena cava interruption with azygous continuation. To our knowledge, this is the first report of esophageal lung with such associations.

Objective: Ossicular discontinuity may result from chronic suppurative otitis media and is usually detected intraoperatively. Our objective is to determine whether a preoperative audiogram can preoperatively predict the presence or absence of ossicular discontinuity. Methods: A cross-sectional study was prospectively run on our patients, aged 12-75 years, ultimately operated on for chronic suppurative otitis media. Preoperative audiograms were analyzed to measure frequency-specific air-bone gap (ABG) cutoff values. Intraoperatively, ossicular chain integrity was carefully checked. Logistic regression analysis was done to obtain a predictive model. Results: A total of 270 patients (306 ears) were included. Frequency-specific ABG cutoff values can predict ossicular discontinuity, namely: high ABGs at 1,000 Hz (>27.5 dB) and 2,000 Hz (>17.5 dB) are the most reliable variables associated with ossicular discontinuity. Conclusion: Preoperative audiograms can predict the presence of ossicular discontinuity in chronic suppurative otitis media. Large ABGs at both 1,000 and 2,000 Hz can predict ossicular discontinuity with a great degree of certainty.

Patient: Male, 2-year-old Final Diagnosis: Aortoesophageal fistula Symptoms: Esophageal foreign body • gastrointestinal bleeding Medication: — Clinical Procedure: — Specialty: Gastroenterology and Hepatology • Pediatrics and Neonatology Objective: Rare disease Background: Button batteries (BBs) can be inhaled or swallowed accidentally, particularly by infants and children, who can present as a surgical emergency with a fatal outcome. This report is of a case of a 2-year-old boy who developed an aortoesophageal fistula (AEF) after swallowing a button battery and was successfully treated using a novel vascular plug device as a bridge to definitive surgical repair. AEF is diagnosed using computed tomography angiography (CTA), after laparotomy, and using aortography. Aortic endovascular stenting and vascular occluder placement is a minimally invasive emergency option until definitive treatment can be provided. The surgical options include repair the aortic defect primarily, or the diseased segment of the aorta is replaced with a graft. Case Report: A 2-year-old boy presented with hematemesis 9 days after ingestion of a button battery, which was removed endoscopically 16 hours after the incident. The patient was resuscitated aggressively and diagnosed to have AEF using computed tomography angiography (CTA). The aorta was successfully repaired using a vascular plug device, which kept the patient safe until the definitive surgical treatment was done 2 months later. The defect was repaired with direct anastomosis and completed with a patch of bovine pericardium, as well as closure of the fistula from the esophageal side with stitches. Conclusions: This report presents a rare but previously reported complication of swallowing a button battery, resulting in an aortoesophageal fistula. The aorta was successfully repaired using a vascular plug as a minimally invasive emergency option, which is considered as a lifesaving procedure and a bridge for definitive repair.

Objectives To evaluate the reliability of high‐resolution CT scans (HRCT scans) in the diagnosis of tympanosclerosis and to determine its benefit to predict the post‐surgical hearing outcome based on comparing radiological and surgical findings. Methods A retrospective study at a tertiary institute included 940 ears that underwent tyampanoplasty for chronic suppurative otitis media (CSOM) between January 2013 and March 2017. Preoperative temporal bone HRCT scans were analyzed to check for the prediction of tympanosclerosis and ossicular fixation. Intraoperatively, ossicular chain integrity was checked. Preoperative and postoperative audiometric evaluations using air‐bone gap (ABG) were compared. A postoperative pure‐tone ABG of 20 dB or less was considered as a successful hearing result. Results are compared with historical control groups, the study has been reviewed and approved by the IRB at the medical research center in Hamad Medical Corporation; however, it is a retrospective study so no informed consent was obtained from the patients. Results The study included 940 ears that underwent tympanoplasties due to CSOM, where 238 out of 940 (25.3%) of ears showed tympanosclerosis during tympanoplasty, intraoperatively, tympanosclerosis was localized to the eardrum in 174 of the 238 involved ears (73.1%), A 64 out of 238 (26.9%) of the ears with tympanosclerosis showed ossicular fixation, divided as 45 ears with Incudo‐malleal fixation, 14 ears with stapes fixation, and 5 ears with triple ossicular fixation. HRCT scan of the temporal bone was suggestive of ossicular chain fixation in 79 cases distributed as 55 incudo‐malleal fixations, 19 stapes fixation, and 5 complete ossicular fixations, with a sensitivity of 96.8%, and specificity of 98%. The audiological results were analyzed, with a patient follow‐up after 6 months. Conclusions Our study showed that CT scans when combined with the clinical findings can be an informative guide to otolaryngologists for preoperative evaluation and counseling of tympanosclerosis surgeries.

Congenital aneurysm of the right atrial appendage is a rare cardiac anomaly with only a few reported cases in the literature. Most of the cases involved adults in their third decade of life. We report a case of congenital aneurysm of the right atrial appendage in a newborn, who initially presented with jaundice and incidentally discovered systolic murmur. The diagnosis was established by enhanced CT scan of the chest and echocardiography that also showed atrial septal defect (ASD) and multiple ventricular septal defects (VSDs). Because of its rare occurrence, diagnosis is difficult and the symptoms may be confused with other causes of right atrial dilation such as Ebstein's anomaly.

Objective: To review the literature about Acute otitis media (AOM).Introduction: AOM is a common condition with an incidence of 10.8/ 100 people per year; it is more common in pediatric age group and tends to occur more in male patients. It is considered the main cause of prescribing antibiotics in pediatrics. Physicians tend to over diagnose this disease leading to an unnecessary antibiotics prescription which exposes the child to an unwanted side effects mainly diarrhea. USA spends $2-3.5 billion per year for the treatment of AOM. Taking these points in our mind, it is important to know how to accurately diagnose this condition and how to treat it and what is the pathophysiology that underlies that disease, all of which are discussed in details in this review article.Methodology: a comprehensive review of the literature about AOM.Results: AOM is a result of different host, environmental, microbiological and genetic factors. It is highly related to upper respiratory infection and the disease is thought to be viral in origin with bacterial superinfection happens later on. Respiratory syncytial virus (RSV) has the best link with AOM. Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis are still the most important pathogens. It is a symptomatic disease; Ear pain is the most important symptom, and bulging of the tympanic membrane is the most important sign that can lead to diagnosis. The American Academy of Pediatrics has put certain guidelines for the treatment of AOM. Prevetive measures play an important role in decreasing of its incidence. Conclusion:AOM has an impact on the child, family, and the community as a whole, in term of health and costs.