Background: In sugammadex-induced anaphylaxis, sugammadex and/or sugammadex-rocuronium complex have possible allergenic epitope. Case: We report a case of sugammadex-induced anaphylaxis during general anesthesia in a 60-year-old male undergoing orthopedic hand surgery, manifesting as profound hypotension and urticaria. The timing of onset was closely associated with sugammadex administration. The patient recovered after extensive therapy including fluid, epinephrine, other vasopressors, steroid, and antihistamine administration. By intradermal skin test which was done at four weeks after anaphylaxis, we confirmed positive reactions to both sugammadex and sugammadex-rocuronium complex. Conclusions: This is a rare case of sugammadex-induced anaphylaxis that both sugammadex and sugammadex-rocuronium complex were confirmed as allergenic epitopes.

Older patients have more asymmetric pectus deformity and they are also risk factors for complications following PE repair. The bridge technique provides a bar dislocation rate of 0%, even in adult patients. This procedure seems to reduce or prevent major complications following PE repair.

Background: Neuroleukemiosis is a rare complication of leukemia. The diagnosis may be delayed owing to non-specific symptoms and the need for special diagnostic modalities. Case: A 70-year-old man in his sixth year of remission from acute myeloid leukemia was referred to the pain clinic for shooting and radiating pain in the left posterior leg. A lumbar spine magnetic resonance imaging showed mild disc bulging of the L2-3, which was insufficient to explain the patient’s symptoms. With insufficient pain response to lumbar epidural block and piriformis injection, we examined both sciatic nerves using an ultrasound and identified an enlarged hypoechoic mass on the left sciatic nerve at mid-thigh level. After that, we biopsied the mass under general anesthesia, and histology confirmed it to be neuroleukemiosis. Conclusions: Ultrasound is an inexpensive, non-invasive, simple, and quick diagnostic modality that can be used as a screening tool in the diagnosis of neuroleukemiosis.

Large solid sacrococygeal teratomas can cause high-output cardiac failure and hydrops. Survival can be achieved only by preterm delivery or intrauterine surgery or minimal invasive therapy. We present a case of a very large sacrococygeal teratoma which we opted for minimal invasive therapy due to the small gestational age. A healthy 27 year old woman, gravida 2 para 1, was referred at 25+2 weeks' gestation with a large solid-cystic type II fetal sacrococygeal teratoma measuring 18 x 16 x 11 cm. There were severe cardiomegaly, dilated inferior vena cava, polyhydramnios, minimal pleural effusion, minimal ascites and skin edema. MCA-PSV was elevated (56 cm/sec). After steroid has been administered for lung maturation, radiofrequency ablation (RFA) was performed at 26 weeks' gestation. A 17-gauge RFA needle was inserted into the tumour in close proximity to the feeding vessel, and three regions were ablated. As fetal hemoglobin level was 7 g/dl, intrauterine transfusion was performed in two steps, before and after the procedure. On further ultrasound follow-up, the ablated portion of the tumour (8.6 x 5.1 cm) became echogenic and avascular. The signs of hydrops did not deteriorate. Four days after the procedure uterine contractions started. In spite of tocolysis, cervix dilated to 8 cm, and Caesarean section was performed at 26+6 weeks' gestation. A 3540 gram female fetus with an APGAR score of 0 at 1st and 5th minute was delivered. The neonate did not respond to resuscitation. The parents declined autopsy. Even though the procedure halted the progression of hydrops without complications, the outcome was poor due to preterm delivery.Supporting information can be found in the online version of this abstract EP22: INNOVATIONS IN OBSTETRIC IMAGING EP22.01An application of ultrasound elastography for uterine cervix assessment during pregnancy Objectives: The aims of this study were: 1) to summarise our experience with elastography technique in obstetrics ultrasound for other than short cervix cases, 2) to determine the additional impact of elastography for vasa previa and placenta previa assessment. Methods: We retrospectively analysed the images and avi files of gray-scale, Doppler studies and elastography transvaginal ultrasonography (TVS) (Accuvix A30 ultrasound machine with transvaginal probe and ElastoScan elastography software (Samsung, Seoul, Korea).The score for visualisation of pathological structure was given (from 0 to 3) for each ultrasonography technique.Results: There were 10 patients with the placenta previa and cervical pathology other than short cervix: 5 patients with placenta previa, 4 with vasa previa, and one with cervical varix. Among patient with placenta previa were two with sponge-like echo in the posterior part of the cervix.Results revealed that the elastography is as good as gray-scale and colour Doppler TVS for the venous structure into the cervical tissue. We didn't find the efficiency of elastography for vasa previa visualisation. Conclusions: Cervical elastography can serve as a supplemen...