Perineal hernias are rare, protruding through a defect, congenital or acquired, of the pelvic floor musculature with intraperitoneal or extraperitoneal content. Anatomically they can be classified as anterior and posterior based on the position relative to the superficial transverse perineal muscle. We present a case of a rare primary posterior perineal hernia that was identified incidentally on computed tomography.

Lymphoepithelial carcinoma (LEC) is a rare malignancy of the salivary gland arising from the parotid in 80% of cases. LEC is indistinguishable histologically from more common non-keratinising undifferentiated nasopharyngeal carcinoma (NPC). Up to 40% of patients with primary LEC present with a cervical metastasis and histological assessment of the primary lesion or nodal metastasis may be reported as NPC. The absence of a nasopharyngeal lesion on imaging and endoscopic assessment together with a parotid mass strengthens the case for a LEC. A retrospective review of three cases of primary parotid LEC presenting to a tertiary head and neck clinic was performed. Clinical information, imaging and histopathology findings are presented in the form of a pictorial review. Two female and one male patient with an average age of 42 years presented with a neck lump. Initial pathology results were poorly differentiated carcinoma (2/3) and possible NPC (1/3). MR neck revealed unilateral parotid masses with ipsilateral cervical lymphadenopathy and assessment of the nasopharynx was negative (3/3). Resection occurred in all patients and consensus was metastatic LEC with parotid primary in all cases (3/3). 2 patients are disease free, and 1 patient is deceased (as a result of disease) at the time of this report. Lymphoepithelial carcinoma is identical histologically to NPC, this pictorial review highlights the need for clinical and radiological correlation to establish the diagnosis.

Anomalous systemic arterial supply to the basal segment of the lung (ABLL) is a rare cause of haemoptysis. ABLL may be complicated by massive haemoptysis, heart failure due to left-to-right shunt and infection. We describe a case of this condition presenting in the third trimester of pregnancy. Computed tomography chest angiogram confirmed the diagnosis. A multidisciplinary approach was necessary to determine treatment, which ultimately consisted of elective caesarean section at 36 weeks and 4 days’ gestation, followed by transarterial embolisation 9 days postpartum.