A 63-year-old woman with a history of Crohn's disease presented with abdominal pain and diarrhea, findings consistent with a flare of her disease. One week after treatment with infliximab, she returned with worsening abdominal symptoms. An abdominal radiograph (Panel A) showed colonic dilatation and intraluminal polypoid filling defects that suggested the presence of innumerable inflammatory pseudopolyps. (In contrast, "thumbprinting" due to submucosal edema has a more uniform haustral distribution.) Colonography by means of volume-rendered computed tomography with an intraluminal perspective (virtual colonoscopy) (Panel B) generated the endoscopic appearance of inflammatory pseudopolyposis. Polyposis syndromes, such as familial adenomatous polyposis, could give rise to a similar appearance on imaging, although the clinical presentation would differ from that of inflammatory pseudopolyposis. A subtotal colectomy was performed, and on gross examination, areas of denuded mucosa surrounding multifocal islands of edematous mucosa were noted.
Arluk G and Pickhardt P. N Engl J Med 2004;350:923
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