Barium Enema Revisited in the Workup for the Diagnosis of Hirschsprung's Disease.

OBJECTIVE: To analyse the diagnostic capacity of barium enema (BE) in the diagnostic investigation for Hirschsprung's disease (HD) was analyzed for transition zone (TZ) identification and rectosigmoid index (RSI) ≤1.0 determination. PATIENTS AND METHODS: BE images were analyzed retrospectively by 2 examiners and the results were compared with the histopathology of rectal biopsies. RESULTS: TZ identification and RSI ≤1.0 were assessed separately and combined in 43 patients. Twelve (27.9%) patients had the diagnosis of HD based on rectal biopsies. TZ identification presented better diagnostic capacity for the 2 examiners than RSI ≤1.0. However, interexaminer agreement was higher for RSI ≤1.0 than for TZ identification. The combination of TZ identification and RSI ≤1.0 increased the sensitivity (83.3%-92.3%) and the negative predictive value (90.4%-92.3%). CONCLUSION: Therefore, the high diagnostic sensitivity of TZ identification combined to RSI ≤1.0 reinforces the usefulness of these BE parameters in the screening for Hirschsprung's disease.

Estudo de 19 casos de adenoma pleomórfico pela ultra-sonografia e tomografia computadorizada / Study of 19 cases of pleomorphic adenoma using ultrasound and computed tomography

Introdução: Os tumores de glândulas salivares são raros, correspondendo a menos de 3% das neoplasias de cabeça e pescoço, havendo variação na incidência e freqüência de tipos histológicos em diferentes estudos. A glândula mais acometida é a parótida e a neoplasia mais freqüente é o adenoma pleomórfico. Objetivo: Analisamos retrospectivamente os exames de imagem - ultra-som (US) e tomografia computadorizada (TC) de 19 pacientes com diagnóstico de adenoma pleomórfico confirmado através de exame histopatológico de parotidectomia, visando encontrar os achados mais freqüentes na caracterização dessa neoplasia. Métodos: A amostra consistiu de 16 mulheres e três homens, com média de idade de 43,2 anos. Destes, 15 pacientes foram avaliados por TC, sendo três também por US, e quatro exclusivamente por US. Resultados: O maior eixo da lesão variou de 1 a 4,4cm, com média de 2,9cm. O aspecto da lesão foi sólido em 72,6% heterogêneo em 22,2% em um caso, a lesão foi descrita como sólida pela tomografia e heterogênea pelo US (única discordância entre os métodos). Quanto aos limites, apenas uma lesão, avaliada unicamente pelo US, não teve seus limites bem definidos. Dos casos avaliados pela TC, apenas um deles não apresentou realce pelo contraste. Conclusão: A maior partes dos adenomas pleomórficos apresentou aspecto sólido (72,6%), quase sempre (94,7%) com limites bem definidos e com realce ao meio de contraste. Em 88,3 % dos casos, o tamanho do maior eixo esteve entre 2 e 4cm.

Introduction: Salivary gland tumors are rare, with variant incidence and frequency of histological subtypes in different studies. The most committed gland is the parotid, and pleomorphic adenoma is the most frequent neoplasm. Objective: Image exams of 19 patients with pleomorphic adenoma were analyzed by ultrasound (US) and computed tomography (CT). Histopathological parotidectomy exam confirmed the diagnosis of pleomorphic adenoma seeking its radiological characterization. Methods: The present study consisted for a group of 16 women and 3 men, with average age of 43.2 years. The main characteristics evaluated in the CT and US were: the aspect (solid, cystic or heterogeneous), the preservation of limits regarding to adjacent parenchyma and the size, and in those CT exams we examined the presence of prominence distinction in a contrastive environment. Results: The lesion size varied from 1 to 4.4cm, with average of 2.9cm. The aspect of the lesion in 12 cases (72.6%) was solid; and in 4 cases (22.2%) was heterogeneous. A unique lesion did not have its limits well defined. Just one case did not present prominence distinction by the contrast. Conclusion: In the evaluated image exams, that neoplasm was characterized by presenting solid aspect (72.6%), nearly always with well defined limits and prominence distinction in a contrastive environment (94,7%). In 88.3% of the cases, the lesion size of the maximum axis observed was between 2 and 4cm.