Pyloric Stenosis

Pyloric stenosis (or infantile hypertrophic pyloric stenosis) is a condition that causes severe vomiting in the first few months of life. There is narrowing (stenosis) of the opening from the stomach to the intestines, due to enlargement (hypertrophy) of the muscle surrounding this opening (the pylorus, meaning “gate”), which spasms when the stomach empties.
mouseover for arrows Image from Radiopaedia.org (Submitted by Dr. Laughlin Dawes)

Case Discussion: This 6 week-old female patient presented with projectile vomiting. The ultrasound shows an elarged pylorus. The length was 16mm (upper limit of normal 14mm), and the muscle thickness was 4mm (upper limit of normal 3mm). This image also shows the “antral nipple sign” – redundant pyloric mucosa protruding into the gastric antrum, and the “cervix sign” – indentation of the pylorus into the fluid-filled antrum. The most telling sign, however, was that no gastric contents were seen to pass through the pylorus at any time during the examination. Pyloric stenosis affects males 4-5 times more often than females. It occurs between 4-8 weeks of life, and presents with non-bilious projectile vomiting. There may be a positive family history. Ultrasound findings include: “target sign” (hypertrophied hypoechoic muscle surrounding echogenic mucosa); elongated pylorus with thickened muscle; “cervix sign”; “antral nipple sign”; exaggerated peristalsis; and failure of the pylorus to open.

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