Background As the pediatric population requiring health services rises globally, developing countries are struggling to cater to the growing burden of non-communicable diseases - particularly those requiring specialized surgical care. Main body Despite the literature supporting specialized pediatric surgical care, the developing world is far from meeting the American Pediatric Surgical Association (APSA) Manpower taskforce recommendation of at least 1 qualified pediatric surgeon per 100,000 patients (0–15 years-old). In Pakistan, there is an unmet surgical need in the pediatric population due to a multitude of short shortcomings, notably in quality and quantity of the training programs on offer, and urgent short- and long-term steps are needed to improve this dire situation. Conclusion It is crucial for the global surgical community to take steps, especially with regards to pediatric surgical training, to ensure delivery of accessible and quality surgical care to the world’s children.

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DesCripTionA 53-year-old man presented with moderate dull non-radiating right upper quadrant pain for the past 1 month. There were no exacerbating or relieving factors or associated symptoms. His medical history was positive for hepatocellular carcinoma for which segmentectomy was performed 6 months ago. On physical examination, he was vitally stable and all systemic examinations were unremarkable. Contrast-enhanced abdominal CT scan showed an enhancing lesion at the surgical bed, representing recurrence of hepatocellular carcinoma (figure 1 and 2). There was also an apparently intracaval fat-density lesion in the suprahepatic part (figure 1 and 2). However, on detailed inspection, particularly on sagittal images (figure 3), its extracaval location became evident, and it was diagnosed as a paracaval pseudolipoma.Pericaval and juxtacaval pseudolipoma mimicking an intracaval mass/thrombus occurs in 0.5% of adults undergoing abdominal CT scan.1 It is found posteriorly or medially to the IVC lumen and can appear different in serial CT scans due to different respiratory depth and pressure.1 The rightward angulation of the IVC and narrowing of the intrahepatic IVC causes the fat in this location to appear within the lumen, particularly on axial images. 2Cognisance of this entity can prevent misdiagnosis and the resulting unnecessary therapy and interventions. CT attenuation values are important when dealing with such masses in the caval region. The uniformity of fat-density seen in these fat collections should enable differentiation from other possible diagnoses. Furthermore, ultrasound and multiplanar reformation of CT images can also prove instrumental in discerning this condition. 3Learning points ► Cognisance of pericaval and juxtacaval pseudolipoma mimicking an intracaval mass/ lesion can prevent misdiagnosis and the resulting unnecessary therapy and interventions. ► CT attenuation values and the uniformity of fat-density in these collections can be used to differentiate them from other possible diagnoses.