Radiology quiz

Dorothy Makanjuola

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RADIOLOGICAL QUIZ

Year : 1997 | Volume : 3 | Issue : 1 | Page : 60-61

Radiology quiz

Dorothy Makanjuola
Department of Radiology, King Khaled University Hospital, Riyadh, Saudi Arabia

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Date of Submission	11-Sep-1996
Date of Acceptance	05-Nov-1996

How to cite this article:
Makanjuola D. Radiology quiz. Saudi J Gastroenterol 1997;3:60-1

How to cite this URL:
Makanjuola D. Radiology quiz. Saudi J Gastroenterol [serial online] 1997 [cited 2022 Jan 21];3:60-1. Available from: https://www.saudijgastro.com/text.asp?1997/3/1/60/33949

Answer of the Radiology Quiz

Confirmed case of ulcerative colitis.

[Figure - 1]: Inflammatory Pseudo Polyps

Barium outlines the left colon revealing lack of haustration and extensive mucosal ulceration in the areas coated by Barium. The black areas of irregular and nodular filling defects represent the relatively surviving mucosa. Barium artifact are present medial to the colon.

[Figure - 2]A & b: Post Inflammatory PSEUDO POLYPS

Five years later and with a history of remission, there has been restoration of the normal colonic profile with haustration. The spot view of the hepatic flexure [Figure - 2]a shows long filiform (open arrows) and small rounded polyps (closed arrow) which are distributed throughout the colon. [Figure - 2]b also shows a unique group of filiform polyps (arrowed) with a rather triangular appearance.

Discussion

The inflammatory and postinflammatory polyps are so called because they are not true neoplasms. The inflammatory pseudopolyps usually occur in the acute phase of inflammatory bowel disease and is classically seen in ulcerative colitis as in the case illustrated. They are scattered islands of relatively normal mucosa in a background of extensive ulceration involving the mucosa and submucosa. Therefore the ulcerated areas coated with barium are falsely perceived as the baseline and the surviving islands of mucosa causing the filling defects as polyps as shown in [Figure - 1].

Post inflammatory pseudopolyps also called inflammatory polyps are usually a sequelae of colitis. During remission there is a tendency to repair process with regeneration of the denuded mucosa. In some patients there is a tendency to overgrowth in some areas. These are represented by round or elongated (filiform) polyps or finger like projections as shown in [Figure - 2].

Majority of these postinflammatory polyps are asymptomatic. However, some could achieve a giant size with consequent intestinal obstruction ^[1] or be a source of hemorrhage. Inflammatory polyps are commonly associated with ulcerative colitis and Crohn's disease, however, other associated conditions include ischemic colitis ^[2] , Graft versus host disease ^[3] , Colorectal prolapse ^[4] and at the anastomosis ^[5] following resection of colonic neoplasm. Filiform polyps have also been described in the stomach and small bowel following Crohn's disease ^[6] .

Differential diagnosis include familiar polyposis syndrome, cobble stoning due to longitudinal and transverse ulcers intersecting edematous mucosa, villous adenoma and mucosal dysplasia ^[7] which is a histologic marker highly associated with adenocarcinoma. Endoscopy and biopsy are required for differentiating such suspicious lesions.

References

1.	Balazs M. Giant inflammatory polyps associated with idiopathic inflammatory bowel disease: an ultrastructural study of five cases. Dis-Colon-Rectum 1990;33:773-7.
2.	Pidala MJ, Slezak FA, Hlivko TJ. Delayed presentation of an inflammatory polyp following colonic ischemia. Am surg 1993;59:315-8. [PUBMED]
3.	Galati JS, Wisecarver JL, Quigley EMM. Inflammatory polyps as a manifestation of intestinal graft versus host disease. Gastrointest-Endosc 1993;39:719-22.
4.	Chetty R, Rhathal PS, Slavin JL. Prolapse-induced inflammatory polyps of the colorectum and anal transitional zone. Histopathology 1993;23:63-7.
5.	Weinstock LB, Shatz BA. Endoscopic abnormalities of the anastomosis following resection of colonica neoplasm. Gastrointest-Endosc 1994;40:558-61. [PUBMED]
6.	Gove RM, Levine MS, Laufer I. Testbook of Gastrointestinal Radiology. Saunders Philadelphia 1994;1(62):1098-1141.
7.	Buck JL, DackmanAH, Soin LH. Polypoid and pseudopolypoid manifestation of inflammatory bowel disease. Radiographics 1991;11:293-304.