Objective: Ultrasonography (US) is the most accurate and cost-effective imaging method in diagnosis of thyroid nodules. A practical thyroid imaging reporting and data system (TIRADS) for thyroid nodules has been proposed to classify nodules of the thyroid gland to solve the problem of nodule selection for fine needle aspiration cytology (FNAC). Real-time elastography and strain ratio (SR) is a method used to assess the stiffness and predict the malignancy of thyroid nodules. The objective of this study was to assess the role of elastography and SR and the TIRADS scoring system in discriminating malignant from benign thyroid nodules. Materials and methods: From 2015 to 2018 at Cairo University Hospital, a series of 409 patients with thyroid nodules was referred to undergo thyroid ultrasound. Categorization of each nodule according to the TIRADS ranged from 1 to 5. The qualitative elastography score and semiquantitative SR of the nodules were evaluated. Final diagnosis was done by either postthyroidectomy histopathological examination or US-guided FNAC. Results: Our study included 409 patients with thyroid nodules. Their mean age was 39 ± 10 SD; 36 were males and 373 were females. There were 22 malignant nodules and 387 benign nodules. There were statistical differences between benign and malignant nodules regarding TIRADS classification, SR, anteroposterior/transverse ratio, degree of echogenicity, border, presence of calcification, and absence of halo sign (P < 0.001). The elastic properties of thyroid nodules proved to be a good discriminator between malignant and benign nodules (P-< 0.001) at a cut off value of > 2.32 with 95.2% sensitivity and 86.5% specificity. For every unit increase in SR, the risk of malignancy increased by nearly 2 times. Patients with irregular borders had nearly 17 times increased risk of malignancy than those with regular borders. Conclusion: Elastography and SR proved to be of high significant value in discriminating benign from malignant nodules, so we recommend adding it to the TIRADS classification.

Introduction: Peritoneal diseases have different types of presentations which can be detected by endosonography. The aim of our study is to assess the performance of ultrasound (US) and US-guided FNA in diagnosis of different peritoneal diseases.Material & methods: we collected the data from 53 Egyptian patients with suspected peritoneal lesions and localized ascites. The detailed sonographic features were assessed for any peritoneal masses, deposits, omental heterogeneity and thickness, and for the detection of any fluid collections. The final diagnosis was reached by the positive cytopathological examination of aspirate taken by FNA. The patients who lost follow up, with severe coagulopathy or whose final diagnosis was not reached were ruled out from the study.Result: ultrasound showed high sensitivity (97.9%) with 95.9% PPV, 75% NPV and 94.34% accuracy while US-FNA shows high specificity (100%) with 100% PPV, 45.45% NPV and 88.68% accuracy rate in diagnosis of different peritoneal diseases. Conclusion:Ultrasound and FNA are very valuable in detection and diagnosis of different peritoneal benign and malignant diseases. In spite of statistically significant increase in sensitivity of US diagnosis of different peritoneal diseases more than that diagnosed by FNAC, yet, US FNA is crucial for confirming the diagnosis for determination of the plan of management of different peritoneal lesions.

Background: SARS-COV2 pandemic had a great impact on our life. Changes had been done to accommodate the current situation. Infection control measures in the endoscopy units had entirely changed. Also, prioritizations of different procedures had changed especially in the lockdown time. Peroral Endoscopic Myotomy (POEM) is considered a low priority endoscopic procedure. Case presentation: We report a 12-year-old child complaining of dysphagia and weight loss who was diagnosed as Type II achalasia. She underwent POEM. According to our Egyptian protocol; COVID-19 was excluded pre-procedural. After POEM, immediately post-procedural chest X-ray was done as usual, and it showed a shadow in the right lung base. Accordingly, HRCT of the chest was done and it showed bilateral asymmetrical patchy areas of ground-glass opacities in the posterior segments of both lower lung lobes (CO-RADS 4). PCR for COVID-19 was positive. Conclusion: We report a very unique COVID-19 case that raises many challengeable issues and shows a useful message about the risk of silent COVID-19 infection in children during the endoscopy. Keywords: achalasia; Poem; 3rd Space endoscopy; COVID-19.