Presentation
Week three of life. Four day history of non-bilious projectile vomiting intermittent with feeding. Otherwise well.
Patient Data
The pyloric muscle is thickened with the muscular layer measuring up to 5mm. Abnormal elongation of the canal is also noted measuring at least 16mm in length. Direct observation of the pyloric canal showed no passage of gastric content.
A double layer of thickened, hyperechoic mucosa protruding through the antrum was also noted, along with an actively peristalsing and distended stomach.
Ultrasound features are in keeping with hypertrophic pyloric stenosis.
Case Discussion
Ultrasound is the most appropriate modality of choice when pyloric stenosis is suspected as it allows direct observation of the pyloric canal.
To avoid gas in the stomach obscuring the view of the pylorus, the infant was placed in an oblique position with the right side down. The fluid within the antrum could then be used as an acoustic window.
Gentle pressure applied to the region of interest also displaces bowel and stomach content, moving the pylorus closer to the probe.
The linear array hockey-stick transducer provided adequate depth with optimal resolution on this particular infant, with the small footprint improving the ability to angle towards the pylorus.
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