Lymphoid follicular pattern in the colon: an indicator of barium coating

A lymphoid follicular pattern was noted more frequently when high-density (100% w/v) replaced low-density (58% w/v) barium in children undergoing double-contrast barium enema examinations. Therefore, a retrospective study was undertaken to compare the presence of follicles seen in 24 consecutive patients under 10 years old given low-density barium with that of 50 patients given high-density barium. The high-density studies revealed follicles in 90% of the children compared with 46% of the children having low-density studies. All follicles were less than 2 mm in diameter. An aphthoid appearance was present in nine of these 50 children. The most common indications for the high-density examination were rectal bleeding and abdominal pain. The final diagnosis was normal bowel in more than two thirds; no child under six years old given high-density barium had inflammatory bowel disease. There was no correlation between final clinical diagnosis and the presence, extent, or severity of the lymphoid follicular pattern.