Year : 1997 | Volume
: 3 | Issue : 1 | Page : 60--61
Department of Radiology, King Khaled University Hospital, Riyadh, Saudi Arabia
Consultant Radiologist, College of Medicine, King Khaled University Hospital, P.O. Box 7805, Riyadh 11472
|How to cite this article:|
Makanjuola D. Radiology quiz.Saudi J Gastroenterol 1997;3:60-61
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Makanjuola D. Radiology quiz. Saudi J Gastroenterol [serial online] 1997 [cited 2022 May 23 ];3:60-61
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.
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  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  , Graft versus host disease  , Colorectal prolapse  and at the anastomosis  following resection of colonic neoplasm. Filiform polyps have also been described in the stomach and small bowel following Crohn's disease  .
Differential diagnosis include familiar polyposis syndrome, cobble stoning due to longitudinal and transverse ulcers intersecting edematous mucosa, villous adenoma and mucosal dysplasia  which is a histologic marker highly associated with adenocarcinoma. Endoscopy and biopsy are required for differentiating such suspicious lesions.
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