ABSTRACT BACKGROUND: Developmental dysplasia of the hip (DDH) encompasses a broad spectrum of hip pathologies, including femoral or acetabular dysplasia, hip instability, or both. According to the medical literature, ultrasonography is the most reliable diagnostic method for DDH. Several techniques for the assessment of hips in newborns and infants, using ultrasonography, have been described. OBJECTIVE: To compare the accuracy of the Graf technique and other diagnostic techniques for DDH. DESIGN AND SETTING: A systematic review of studies that analyzed ultrasound techniques for the diagnosis of DDH within an evidence-based health program of a federal university in São Paulo (SP), Brazil. METHODS: A systematic search of relevant literature was conducted in the PubMed, EMBASE, Cochrane Library, CINAHL, and LILACS databases for articles published up to May 5, 2020, relating to studies evaluating the diagnostic accuracy of different ultrasound techniques for diagnosing DDH. The QUADAS 2 tool was used for methodological quality evaluation. RESULTS: All hips were analyzed using the Graf method as a reference standard. The Morin technique had the highest rate of sensitivity, at 81.12–89.47%. The Suzuki and Stress tests showed 100% specificity. The Harcke technique showed a sensibility of 18.21% and specificity of 99.32%. CONCLUSION: All the techniques demonstrated at least one rate (sensibility and specificity) lower than 90.00% when compared to the Graf method. The Morin technique, as evaluated in this systematic review, is recommended after the Graf method because it has the highest sensitivity, especially with the three-pattern classification of 89.47%. REGISTRATION NUMBER: Identifier: CRD42020189686 at the International Prospective Register of Systematic Reviews (identifier: CRD42020189686).

ABSTRACT BACKGROUND: Developmental dysplasia of the hip (DDH) encompasses a broad spectrum of hip pathologies, including femoral or acetabular dysplasia, hip instability, or both. According to the medical literature, ultrasonography is the most reliable diagnostic method for DDH. Several techniques for the assessment of hips in newborns and infants, using ultrasonography, have been described. OBJECTIVE: To compare the accuracy of the Graf technique and other diagnostic techniques for DDH. DESIGN AND SETTING: A systematic review of studies that analyzed ultrasound techniques for the diagnosis of DDH within an evidence-based health program of a federal university in São Paulo (SP), Brazil. METHODS: A systematic search of relevant literature was conducted in the PubMed, EMBASE, Cochrane Library, CINAHL, and LILACS databases for articles published up to May 5, 2020, relating to studies evaluating the diagnostic accuracy of different ultrasound techniques for diagnosing DDH. The QUADAS 2 tool was used for methodological quality evaluation. RESULTS: All hips were analyzed using the Graf method as a reference standard. The Morin technique had the highest rate of sensitivity, at 81.12–89.47%. The Suzuki and Stress tests showed 100% specificity. The Harcke technique showed a sensibility of 18.21% and specificity of 99.32%. CONCLUSION: All the techniques demonstrated at least one rate (sensibility and specificity) lower than 90.00% when compared to the Graf method. The Morin technique, as evaluated in this systematic review, is recommended after the Graf method because it has the highest sensitivity, especially with the three-pattern classification of 89.47%. REGISTRATION NUMBER: Identifier: CRD42020189686 at the International Prospective Register of Systematic Reviews (identifier: CRD42020189686).

RESUMO Paciente do sexo masculino, 41 anos de idade, relata tumor doloroso na face lateral da perna direita. A ultrassonografia demonstrou massa volumosa, hipoecogênica, heterogênea e bem delineada no tecido subcutâneo, com área hiperecogênica em seu interior. A ressonância magnética (RM) revelou um tumor ovalado e lobulado, com margens bem definidas na parte anterolateral da perna, apresentando realce pelo contraste. O estudo anatomopatológico constatou neoplasia com extensa matriz condromixoide. O estudo imuno-histoquímico apresentou vimentina (clone V9) e proteína S-100 positivas e desmina (clone D33), actina de músculo liso (1A4), CD68 (clone KP1) e caldesmon negativos. O conjunto de achados é compatível com lipossarcoma mixoide.

ABSTRACT A 41-year-old male patient refers to a painful tumor on the lateral side of the right leg. Ultrasonography visualized a predominantly hypoechoic well-delineated large heterogeneous mass in the subcutaneous tissue, showing an internal hyperechoic area. Magnetic resonance imaging (MRI) demonstrated an oval and lobulated tumor with well-defined margins at the anterolateral part of the leg, with contrast enhancement. The anatomopathological evaluation revealed a neoplasm with an extensive chondromyxoid matrix. The immunohistochemical study demonstrated positive vimentin (V9 clone), positive S-100 protein and negative desmin (D33 clone), smooth muscle actin (1A4), CD68 (KP1 clone) and caldesmon. The set of findings is compatible with myxoid liposarcoma.

RESUMEN Paciente masculino de 41 años de edad, reporta tumor doloroso en la parte lateral de la pierna derecha. La ultrasonografía demostró una masa voluminosa, hipoecogénica, heterogénea y bien delimitada en el tejido subcutáneo, con área hiperecogénica en su interior. La resonancia magnética (RM) reveló un tumor ovalado y lobulado, con márgenes bien definidas en la parte anterolateral de la pierna, presentando realce de contraste. El estudio anatomopatológico constató neoplasia con abundante matriz condromixoide. La inmunohistoquímica presentó vimentina (clon V9) y proteína S-100 positivas, y desmina (clon D33), actina de músculo liso (1A4), CD68 (clon KP1) y caldesmón negativos. El conjunto de hallazgos es compatible con liposarcoma mixoide.

RESUMO Paciente do sexo masculino, 45 anos de idade, apresenta cefaleia occipital há cerca de um mês, resistente ao tratamento com analgesia, e nódulo palpável no local da dor, medindo 1,5 cm de diâmetro, sem aparente alteração da pele. A ultrassonografia revelou uma lesão osteolítica com margens bem definidas e discutível comunicação com a dura-máter. O estudo foi complementado com tomografia computadorizada (TC) e ressonância magnética (RM) com contraste, ambos os exames identificando lesão lítica com componente de partes moles e realce pelo contraste, sem restrição à difusão, orientando a hipótese diagnóstica de granuloma eosinofílico (GE). Instituiu-se então o tratamento cirúrgico com excisão da massa e avaliação anatomopatológica, que confirmou a hipótese diagnóstica radiológica. Com três meses de seguimento, o paciente estava livre de sintomas, e o controle radiográfico não evidenciava sinais de recidiva.

ABSTRACT A 45-year-old man presents with occipital headache for about one month, resistant to analgesic therapy, and palpable nodule at the pain site. At initial evaluation, the nodule was 1.5 cm in diameter without apparent skin alteration. Ultrasonography revealed a well-defined osteolytic lesion and doubtful communication with the dura mater. The study was complemented with computed tomography and contrast-enhanced magnetic resonance, both identifying lytic lesion with soft tissue component and contrast enhancement, without diffusion restriction, guiding the diagnostic hypothesis of eosinophilic granuloma. Surgical treatment with mass excision and anatomopathological evaluation was made, which confirmed the radiological diagnostic hypothesis. After three months of follow-up, the patient remained symptom-free and radiographic control showed no signs of relapse.

RESUMEN Paciente varón de 45 años presenta cefalea occipital desde hace un mes, refractaria a tratamiento analgésico, y nódulo palpable en el lugar del dolor, que mide 1,5 cm de diámetro, sin alteración visible de la piel. La ecografía reveló una lesión osteolítica de bordes bien delimitados y comunicación dudosa con la duramadre. Se complementó el estudio con tomografía computarizada (TC) e imagen por resonancia magnética (IRM) con medio de contraste, ambos exámenes identificando lesión lítica con componente de partes blandas y realce del contraste, sin restricción a la difusión, planteando la hipótesis diagnóstica de granuloma eosinófilo (GE). Se instauró el tratamiento quirúrgico con escisión de la masa y examen anatomopatológico, que confirmó la hipótesis diagnóstica radiológica. A los tres meses de seguimiento, el paciente estaba libre de síntomas, y el control radiográfico no mostró señales de recidiva.

RESUMO Paciente do sexo masculino, 4 anos de idade, com cefaleia há 18 meses associada à perda progressiva do equilíbrio e à dificuldade de deambulação. A ressonância magnética (RM) demonstrou uma lesão expansiva extra-axial na porção posterior da fossa posterior à esquerda, comprimindo o cérebro adjacente, bem como os hemisférios cerebelares; ainda distorce o quarto ventrículo com hidrocefalia obstrutiva grave a montante. A avaliação histológica diagnosticou osteoblastoma agressivo com cisto ósseo aneurismático secundário do crânio. Relatamos um caso de osteoblastoma agressivo em que a lesão na RM estava mimetizando tumor cerebral ou tumor primário intracraniano em vez de tumor ósseo primário.

ABSTRACT A 4-year-old male patient presented with headaches that started 18 months ago and were associated with progressive loss of balance and difficulty walking. Magnetic resonance imaging (MRI) demonstrated an expansile extra-axial mass lesion in the posterior aspect of the posterior fossa on the left, compressing the adjacent brain, as well as the cerebellar hemispheres; it also distorts the fourth ventricle with severe obstructive hydrocephalus upstream. Histological evaluation diagnosed aggressive osteoblastoma with a secondary aneurysmal bone cyst of the skull. We report a case of aggressive osteoblastoma in which the lesion in the MRI was mimicking brain tumor or intracranial primary tumor rather than primary bone tumor.

RESUMEN Paciente masculino, de 4 años de edad, con cefalea de 18 meses asociada a pérdida progresiva de equilibrio y dificultad de deambulación. La resonancia magnética (RM) mostró una lesión espansiva extraaxial en la porción posterior de la fosa posterior a la izquierda, comprimiendo el tejido cerebral adyacente, así como los hemisferios cerebelares; aún deforma el cuarto ventrículo con hidrocefalia obstructiva severa. La evaluación histológica diagnosticó osteoblastoma agresivo con quiste óseo aneurismático secundario del cráneo. Reportamos un caso de osteoblastoma agresivo en lo cual la lesión visualizada con la RM estaba mimetizando tumor cerebral o tumor primario intracraniano y no un tumor óseo primario.