A 14‐month‐old boy who presented with left external auditory canal mass noticed by his parent shortly after birth. Clinically, mass was small, soft and nearly obstructing external auditory meatus. Surgical excision of mass with final histopathological diagnosis confirmed to be hemangioma. Patient followed up for 12 months post‐surgery with no recurrence.

Introduction: Tracheostomy related tracheal tear is a serious complication that may follow surgical or percutaneous tracheostomy. Pediatric populations carry higher risk because of the anatomical differences. The aim of this article is to review this condition and to help in their diagnosis and management with assistance of clinical and radiological findings. Methods and Materials: An English literature review was done using the terms pediatric, tracheostomy, tracheal tear and tracheostomy tube. Result: Two cases reported in literature that met criteria. Discussion: It needs immediate diagnosis as may lead to life threatening outcomes such as pneumothorax, respiratory distress, extensive subcutaneous emphysema and pneumomediastinum. Symptoms and complications of the tear may occur intraoperatively or postoperatively. Gold standard methods for diagnosis will be established by flexible or rigid tracheobronchoscopy which helps in determining management plan. Treatment of iatrogenic tracheal tears choices depends on tear site, size, and extension of the tear and patient’s hemodynamic status. Conservative management is sufficient for stable patients with small tears, whereas surgical management is essential for unstable patients and those with large or complicated tears. Conclusion: Tracheostomy related tracheal tear is a serious rare complication. Pediatric age group carry higher risk and management either conservative or surgical depend on airway endoscopy finding and patient’s hemodynamic status.

Background: Fatty liver is a disease caused by the accumulation of fat in the liver. It is one of the major risk factors for developing cirrhosis and hepatocellular carcinoma. Saudi Arabia is one of the most prevalent countries in diabetes and obesity; the overall prevalence of diabetes is 23.7% and obesity is 35.6%. Aim: To study the correlation between fatty liver finding on abdominal ultrasound (US) and their clinical and biochemical profile including BMI, blood glucose level, lipid profile, liver function tests, and blood pressure in both group lean and obese patients. Methods: Cross-sectional study of 346 fatty liver ultrasound-proven patients were enrolled in the study from January to May 2016 in King Saud Hospital- Qassim, Saudi Arabia. Results: Mean age of the participants was 50.3 years. Female participants were 55% of the cohort. Participants were divided based on their BMI: BMI <25 (lean), BMI of 25–30 (overweight and mild obesity), and BMI >30 (morbid obesity). We found that cholesterol ( P = 0.007) and low-density lipoprotein (LDL) ( P = 0.015) were higher in lean compared to others (5 and 3.1), respectively. Gamma-glutamyl transferase (GGT) was higher in mildly obese patients (113.2) and ALT, which was higher in lean patients (60.4). In addition, 34.5% of the overall patients had Diabetes Mellitus (DM). We found that HbA1c was lower in lean (7.3) compared to morbidly obese patients (7.6). Platelets counts were higher in morbidly obese patients (278) compared to other groups. Conclusion: High cholesterol and LDL strongly correlated with lean fatty liver patients. There was a significant relationship between the female gender and the risk of development of fatty liver. However, liver enzymes were within the normal range, except GGT, which was higher in all the groups, with the highest value in mildly obese patients. Therefore, they are not sensitive for diagnosing fatty liver patients.

Tracheostomy related tracheal tear is a serious complication that may follows surgical or percutaneous tracheostomy. Pediatric populations carry higher risk because of the anatomical differences. It needs immediate diagnosis as may leads to life threatening outcomes such as pneumothorax, respiratory distress, extensive subcutaneous emphysema and pneumomediastinum. The best way to diagnose and discover tracheal tear is by tracheobronchoscopy. If the diagnosis established prompt management and treatment should be performed. Objective The aim of this article is to review tracheal tears and to help in their diagnosis and management with assistance of clinical and radiological findings. Methods and Materials A literature review of PubMed , ovid Medline and cochrane collaboration databases was done using the terms pediatric , tracheostomy , tracheal tear. Discussion Tracheostomy related tracheal tear occurs infrequently and less commonly than intubation related tracheal tear. Mostly it is related to tracheostomy placement, using cuffed tubes and overinflation of the cuff or the tear directly follows traumatizing tracheostomy tube introducer insertion. The tear due to tracheostomy mostly located proximal to carina and distal to insertion of point of tracheostomy. Symptoms and complications of the tear may occur intraopertivly or postoperatively(5). Gold standard method for diagnosis will be established by flexible or rigid tracheobronchoscopy which helps in determining the site, size, extension of the tear and its location with respect to the carina that are essential to document. Imaging studies like CT scan which also helps in establishing the diagnosis of tear and some of it is complications such as pneumothorax, pneumonia, pneumomediastinum and mediastinitis. Treatment can be conservative for small uncomplicated wound in stable patient. For larger complicated tears and unstable patient surgical treatment is the gold standard. Conclusion Treatment choices depend on tear site , size, extension of the tear and the status of the patient. Conservative management is sufficient for stable patients with small tears . On the other hand , surgical management is essential for unstable patients and large complicated wounds.