24-year-old woman was presented with huge vulval mass for which she was operated, histopathological report of that mass shows angiomyoma. After few months she was discovered to have a giant retroperitoneal tumor incidentally during her routine obstetric examination at 24 weeks of gestation. Initial investigation by abdominal-pelvic computed tomography (CT) (18/08/18) revealed an a large multiseptated soft tissue attenuated minimally enhancing pelvic mass (31.8cmx13.2x 24cm) protruding in the abdominal cavity displacing the bowel loops proximally and pushing retro organs posteriorly. She underwent laparotomy with preservation of the fetus at 24 weeks of gestation. Final diagnosis was made after HPE report which shows myxoid liposarcoma. She was referred to regional cancer hospital for radiotherapy and then patient lost in follow up.

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A 14 years old girl presented to the gynecology OPD with pain abdomen and huge abdominal lump since 2 months. On clinical examination, a large mass of 20x15 cm size was found extended upto the xiphoid process. Serum studies showed rise of CA-125 up to 406.9U/mL and LDH up to 310U/L. USG shows right ovarian cyst of 14.8x14.1x12.8 cm with internal calcification. MRI revealed a well encapsulated mass of 21x19x17cm with solid and cystic mass and upward peritoneal extension. Exploratory laparotomy was performed with right sided salpingo- ophorectomy with infracolic omentectomy, as the omentum appeared granular. She had an uneventful post-operative recovery. Subsequently HPE showed immature teratoma NORRIS grade 3 with co-existent peritoneal gliomatosis (grade 0). She is under regular follow-up and decided to give six cycles of combination chemotherapy with BEP at regional cancer hospital.

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The ultrasound has been in clinical use since the early 1900s, but its use in the airway has not been published extensively so far. Combining the skills of USG with thorough knowledge of regional anatomy can prove to be a boon to improving the quality of care being delivered to patients. Preoperative use of USG at different levels of the neck combined with the risk assessment methods can help to organize predictors of difficult airway and difficult laryngoscopy. Basic comprehension of USG physics, transducer selection, and probe orientation and a better understanding of airway anatomy contribute to the accuracy of ultrasound interpretation. In day-to-day practice, there is a potential for failed tracheal intubations followed by failure of gaining adequate access to the airway, thus posing challenges to anesthesiologists. Besides predicting difficult airway, USG provides an incentive to properly place an endotracheal tube (ETT) to an adequate depth, estimation of the size of ETT particularly helpful in children and obese, laryngeal mask airway (LMA) confirmation, surgical airways, and post-extubation stridor assessment and thus prevents the risk of reintubation. With the promising and increasing number of evidence exists, there is potential for incorporation of upper airway USG into further standard of care assessment, monitoring, and imaging modalities.