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Background: Percutaneous Transhepatic Biliary Drainage (PTBD) is performed either via right or left-ductal approach, on the basis of status of primary confluence, secondary confluence and atrophy of liver parenchyma. Our study compares the complications of two approaches in malignant obstruction. The objectives of this study was to assess and compare complications of PTBD.Methods: This study was a prospective hospital based study performed for a period of 2 years from 2016 to 2018.PTBD was performed either via right in 16 patients or left-ductal approach in 15 patients, on the basis of status of primary biliary confluence and atrophy of liver parenchyma.Results: Both minor and major complications were more common in right-sided approach as compared to left-sided approach with most common major and minor complication being cholangitis (16.12%) and fever (12.9%) respectively.Conclusions: PTBD is an excellent palliative procedure to drain the bile ducts in malignant obstruction. Although complications of PTBD are more common in right sided approach but results are statistically insignificant.

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Objective: To assess the various presentations of abdominal ascariasis and their imaging features for developing a comprehensive radiological evaluation protocol. Methods: Demographic and clinical profile of 84 patients with abdominal ascariasis was noted. Patients were divided into 2 groups with age less than 20 comprising Group A and those with age greater than 20 Group B. All the patients had a routine lab workup and a dedicated USG scan to look for objective evidence of intestinal or hepatobiliary ascariasis. Any history of previous intervention (cholecystectomy or ERCP) was also sought. Results: Abdominal ascariasis is more common in females observed in 62% of our patients. Peripheral eosinophilia was observed in 70 (83%) patients. We had 74 (88%) patients with intestinal ascariasis with 2 patients having appendicular ascariasis. Biliary ascariasis was observed in 20 (24%) patients and pancreatic ductal ascariasis in 6 (7%) patients. We found peritoneal ascariasis in 1 (2%) pediatric patient and 2 (3%) patients in our study had ascariasis associated with the liver abscess. OCH was observed in 4 patients while 2 patients presented with worm cholecystitis. Conclusion: Peripheral eosinophilia can be used to select patients in endemic regions for undergoing a dedicated USG scan. USG is the investigation of choice for both intestinal and hepatobiliary ascariasis. Worm migration is more common in adults and is especially prevalent in individuals with previous history of ERCP or cholecystectomy.

Thoracic Duct Cysts (TDCs) are exceedingly rare benign masses of the posterior mediastinum. They are thought to arise from congenital or degenerative weakening in the thoracic duct wall. We bring to light an incidentally detected posterior mediastinal cystic lesion that caused dysphagia in our patient and was found to be a thoracic duct cyst.

The length of the styloid process varies greatly in different populations and depends on ethnicity and geographical background. The elongated styloid process may be associated with Eagle’s syndrome. Therefore, the mean normal length of the styloid process in different population groups needs to be calculated and the upper cutoff limit for elongated styloid process should be found. The objective of the research was to evaluate the styloid process length in the Kashmiri population using multidetector computed tomography. Materials and Methods. We retrospectively evaluated 304 patients who underwent computed tomography of the head and paranasal sinuses, and the mean styloid process length was calculated on both sides. The mean of three measurements of styloid process length was taken. The study population was grouped as follows: Group I included patients at the age of 21-30 years; Group II comprised patients at the age of 31-40 years; Group III included 68 patients at the age of 41-50 years; Group IV comprised patients > 50 years old. Results. The mean length of the styloid process in the studied population varied from 20 to 51 mm (mean 31.3 ± 4.5 mm). There was no significant difference in the length on both sides (p=0.835). The mean length of the styloid process was 30.1 ± 4.2 mm in females and 32.3 ± 4.8 mm in males (p< 0.034). The lengths of the styloid process in different age groups were as follows: in Group I - 30.9 ± 4.4 mm; in Group II - 31.2 ± 4.8 mm; in Group III - 31.6 ± 4.3 mm; in Group IV - 31.5 ± 4.5 mm. Conclusions. The mean length of the styloid process in our population was higher as compared to many other ethnic groups. The styloid process in males was longer. The elongated styloid process on computed tomography scan should not be labeled as Eagle’s syndrome unless clinical symptoms are present.

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