Imaging Case: Answer
Answer: False. Infants present with non-bilious vomiting
Diagnosis: Pyloric Stenosis
Pathology: Pyloric stenosis is hypertrophy and hyperplasia of the pylorus with a multifactorial inheritance in families. The incidence is 5/1000 births in males and 2/1000 births in females. It is therefore more common in males; it is also more common in first-born infants, and in Caucasian infants.
Presentation: An infant will present with non-bilious vomiting that becomes projectile, usually between the ages of 3 weeks to 6 months.
Ultrasound: Considered the standard for diagnosis with an accuracy of 100%, sensitivity approaches 97%
Maximum Normal Measurements of the pylorus: Length 15mm
Single muscle: 3mm
Total Width: 7mm
Findings Consistent with Hypertrophic Pyloric Stenosis:
String Sign: Elongated pylorus with a narrow lumen with only small barium streaks passing through
Antral Nipple Sign: Redundant pyloric mucosa projecting into gastric antrum
Cervix Sign: Indentation of muscle mass on antrum.
Target Sign: Hypertrophied, hypoechoic muscle surrounding echogenic mucosa:
- Check BMP patients are at risk for hypochloremic, hypokalemic metabolic alkalosis from repeated vomiting episodes
- Rehydration therapy and correction of electrolyte imbalances, if indicated
- Definitive therapy with pyloromyotomy (surgery)
Disposition: Admission. Patients typically go to surgical floor, however level of care is dependent upon lab values and clinical stability.
1. Radiopedia: Pyloric Stenosis