Filiform polyposis presents a characteristic radiographic appearance consisting of long, filamentous filling defects in an otherwise normal colon. It has previously been reported in patients with a prior history of ulcerative colitis and in one patient with granulomatous colitis. The authors document its development in patients with ulcerative and granulomatous colitis. The authors have also seen a solitary filiform polyp in a patient with previously undiagnosed inflammatory bowel disease, and filiform polyps in the stomach in a patient with documented Crohn disease involving the small bowel. It is believed that this represents a nonspecific sequela of diffuse mucosal inflammation; it should not be mistaken for a neoplastic form of polyposis.

IntroductionCarney complex is a multiple neoplasia syndrome involving cardiac, endocrine, neural and cutaneous tumors with a variety of pigmented skin lesions. It has an autosomal dominant mode of inheritance. Approximately 7% of cardiac myxomas are related to the Carney complex. Myxomas that occur as part of the Carney complex affect both sexes with equal frequency. Cardiac myxomas with Carney complex are reported mostly in the left side of the heart and are less common on the right side. As per our review, this is the first reported case of Carney complex with right ventricle cardiac myxoma.Case presentationWe present a rare case of recurrent cardiac myxoma in a patient later diagnosed to have Carney complex. A 46-year-old Caucasian man with a history of thyroid hyperplasia came to out-patient cardiology department with new onset atrial fibrillation. A transthoracic echocardiogram revealed a right ventricular mass attached to his interventricular septum, which was later seen on a transesophageal echocardiogram and cardiac magnetic resonance imaging. He underwent resection of the ventricular mass which on pathology revealed myxoma. He later developed skin lesions, pituitary adenoma and Sertoli cell tumor suggesting Carney complex. Two years later he developed a new mass within his right atrium which was later resected.ConclusionsCarney complex is a rare autosomal dominant disease with variable penetrance. Since it involves multiple organs, patients diagnosed with Carney complex should undergo serial endocrine workup, neural assessments, echocardiograms and testicular ultrasounds. Of the total number of cases of Carney complex, 65% are linked to PRKAR1A gene mutation. It is important for clinicians to be cognizant of a link between cardiac myxoma and Carney complex. The use of multi-imaging modalities allows better delineation of the mass before planned resection. Carney complex-related cardiac myxoma comprises 7% of all cardiac myxomas. Right ventricular cardiac myxomas are rare. This case report is the first to describe right ventricular myxoma with Carney complex.

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This study evaluates the ability of paraspinal ultrasonography to identify abnormal echogenicity in patients with cervical or lumbar back pain, or both. Paraspinal ultrasonography was performed on 82 subjects, including 23 asymptomatic controls. Echogenicity in the region of nerve roots and facets was assessed. Readings were correlated with location of patients' symptoms, if any. Receiver operating characteristic analysis demonstrated that evaluation of nerve roots by all four readers did not differ significantly from chance (0.07 < P < 0.99). Specificities ranged from 0 to 0.68. Kappa values were 0.06 for cervical and -0.06 for lumbar spine. Ultrasonography was unable to demonstrate abnormal echogenicity adjacent to facets in symptomatic patients. Paraspinal ultrasonography is neither accurate nor reproducible in evaluating patients with cervical and lumbar back pain.

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The purpose of this study was to evaluate the feasibility of intraoperative ultrasonography to guide cryoablation of renal masses. Renal cryoablation was performed on six patients with solid renal tumors. Under ultrasonographic guidance, cryoprobes measuring 3 mm in diameter were placed into the renal tumor parenchyma or into surrounding normal parenchyma. Intraoperative ultrasonography accurately delineated tumor size, cryoprobe placement, and depth of freezing. An echogenic interface was generated by the marked impedance differences at the junction of the normal renal parenchyma and frozen tissue. In addition, intraoperative ultrasonography identified a total of nine additional lesions in three patients that were not detected by preoperative imaging. These lesions also were treated cryosurgically during the same operation. There were no deaths. The patients have been followed with clinical and laboratory assessments as well as with MR imaging or CT scanning, and all have remained tumor free 3 to 22 months postoperatively. Ultrasonographically guided renal cryoablation is a feasible technique for treating malignant renal tumors while preserving renal parenchyma. Long-term follow-up studies in a larger series of patients are required to determine the true efficacy and safety of this procedure.

The ultrasonic characteristics of bilomas are reviewed in five patients, one of whom was also studied with computed x-ray tomography. Certain features not previously reported should aid in differentiating bilomas from other intra-abdominal fluid collections.