Purpose To assess the influence of various patient-, lesion-, and procedure-related variables on the occurrence of pneumothorax as a complication of CT-guided percutaneous transthoracic needle biopsy. Material and methods In a total of 208 patients, 215 lung/mediastinal lesions (seven patients were biopsied twice) were sampled under CT guidance using coaxial biopsy set via percutaneous transthoracic approach. Incidence of post procedure pneumothorax was seen and the influence of various patient-, lesion-, and procedure-related variables on the frequency of pneumothorax with special emphasis on procedural factors like dwell time and needle-pleural angle was analysed. Results Pneumothorax occurred in 25.12% (54/215) of patients. Increased incidence of pneumothorax had a statistically significant correlation with age of the patient ( p = 0.0020), size ( p = 0.0044) and depth ( p = 0.0001) of the lesion, and needle-pleural angle ( p = 0.0200). Gender of the patient ( p = 0.7761), emphysema ( p = 0.2724), site of the lesion ( p = 0.9320), needle gauge ( p = 0.7250), patient position ( p = 0.9839), and dwell time ( p = 0.9330) had no significant impact on the pneumothorax rate. Conclusions This study demonstrated a significant effect of the age of the patient, size and depth of the lesion, and needle-pleural angle on the incidence of post-procedural pneumothorax. Emphysema as such had no effect on pneumothorax rate, but once pneumothorax occurred, emphysematous patients were more likely to be symptomatic, necessitating chest tube placement. Gender of the patient, site of the lesion, patient position during the procedure, and dwell time had no statistically significant relation with the frequency of post-procedural pneumothorax. Surprisingly, needle gauge had no significant effect on pneumothorax frequency, but due to the small sample size, non-randomisation, and bias in needle size selection as per lesion size, further studies are required to fully elucidate the causal relationship between needle size and post-procedural pneumothorax rate. The needle should be as perpendicular as possible to the pleura (needle-pleural angle close to 90°), to minimise the possibility of pneumothorax after percutaneous transthoracic needle biopsy.

Background: Change in tracheal bifurcation angle (subcarinal angle) is an indirect marker of various cardiac, pulmonary and mediastinal pathologies. Helical computed tomography (CT) allows acquisition of volumetric set of data of the chest and can be used for accurate measurements of subcarinal angle using reconstructed images on a workstation using minimum intensity projection (MinIP).The objective of this study was to estimate normal subcarinal angle (SCA) of trachea by computed tomography and to assess its relationship with gender.Methods: This was an observational study comprising a study cohort of 552 patients comprising of 312 males and 240 females who were subjected to CT chest for various indications in our department. Patients with no underlying cardiac, mediastinal or pulmonary disease were included in the study. Spiral CT scan of chest was performed on 64-slice seimens CT SOMATOM and images were reconstructed with thickness of 1.5mm and the images were viewed in coronal reformatted minimum intensity projection (MinIP) for determination of subcarinal angle using the angle measuring tool provided in the workstationResults: The mean subcarinal angle (SCA) in males was (67.60±14.55). The mean subcarinal angle (SCA) in females was (78.90±11.04). Females had a higher mean SCA compared to males with a statistically significant difference (p-value <0.05).Conclusions: The mean SCA in females was higher compared to males with a statistically significant difference between the two. This study holds practical relevance with regard to the performance of invasive trachea-bronchial procedures like bronchoscopy and tracheal/bronchial intubation.

Background: The sphenoid sinus shows multitude of variations in pneumatization, size and pattern of septations leading to differences in its segmentation. Pre-operative knowledge of their attachment especially to posterolateral bony walls covering vital structures is of utmost importance for a safe trans-sphenoidal approach for various surgical procedures involving skull base. Non-contrast computed tomography (NCCT) with its ability to provide multiplanar reformations (MPR) with sharp algorithms is now a reference standard for visualization of these intra-sphenoid sinus septations preoperatively. The objective of this study was to determine the number and attachment of intra-sphenoid sinus septations in a Kashmiri population sample.Methods: NCCT head images of 591 patients in the age range of 16 to 75 years were analyzed retrospectively. Individuals with age less than 16 years, previous surgery involving skull base/sphenoid sinus, trauma causing hem sinus/fractures around skull base or having space occupying lesions around skull base/sphenoid sinus were excluded from the study. On the CT workstation multi-planar coronal, sagittal and axial reconstructions were performed and subsequently examined.Results: The age range was 16 to 75 years with mean age of 43.56 years of which 453 (76.6%) were males and 138 (23.4%) were females. Single intra-sphenoid septation was the most common anatomic variant in present study (79.7%) being complete in 71.7% and partial or incomplete in 8% of the examined subjects. Double septa were found in 11% inpresent study and more than 2 septae in 3.4%. After sellar attachment (51%) the next most common site of attachment was to the carotid canal (29.5%) (23% to left ICA and 6.5% to the right ICA).Conclusions: Intricate knowledge about sphenoid sinus, its pneumatization and anatomical variations in intra-sphenoid sinus septations and its relationship with the surrounding vital structures is of utmost importance before performing any endoscopic/open surgery involving skull base via trans-sphenoidal approach. The present study shows that a significant percentage of septal attachment to the carotid canal makes main sphenoidal septum as not so reliable landmark for endoscopic procedures as used to be in the pre-imaging era. Thus, preoperative CT is mandatory to avoid injuries to para-sellar neurovascular and glandular structures.

Background: Intussusception being the leading cause of acute abdomen in childhood, its timely and accurate diagnosis assumes utmost significance in reducing the morbidity and mortality.  Childhood intussusceptions are still managed surgically in our region; however, non-operative reduction has now become the gold standard of treatment worldwide. In this study, authors desired to evaluate the suitability and effectiveness of hydrostatic reduction of intussusception under ultrasound (USG)-guidance and to scrutinize the factors affecting the successful outcome.Methods: Ours was a prospective study carried out at a tertiary care centre in central Kashmir. All except those with clinical features of bowel gangrene, intestinal prolapse and peritonitis underwent ultrasound-guided hydrostatic reduction (USGHR). A maximum of three attempts were allowed.Results: Mean age of the patients was 11.2±8.8 months with age range of 3-50 months. 69.1% (n=38) of the patients presented within 24 h of being symptomatic while 30.9% had delayed presentation (>24 h). The success rate of USGHR was 81.8% (n=45). Late presentation, age and gender of the patients had no influence on successful outcome of the procedure, p >0.005. The duration of hospital stay between those who had successful hydrostatic reduction and those who afterwards underwent operative reduction or resection achieved statistical significance, p=0.0015.  Authors attained a 66.2 % (45/68) reduction in operative management using USGHR as the main modality of treatment.Conclusions: USGHR is a simple, safe and effective non-operative method of treating intussusceptions in children in a limited resource setting.

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Unicornuate uterus with a non-communicating horn is a rare anomaly and even rarer pregnancy in its noncommunicating horn. The incidence of pregnancy in the non-communicating horn is 1 in 76,000 to 1 in 150,000. Due to non-compliant uterine musculature in the noncommunicating horn, it is prone to rupture in cases of pregnancy. The rupture occurs usually in the second trimester. We describe a case which presented with the rupture of non-communicating horn with live fetus inside it. The present case had a 22 week fetus floating in the peritoneal cavity following the rupture of non-communicating horn with normal other uterine horn.

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