Case 4
History:
Four week-old infant who presented with post-prandial vomiting and failure to thrive.
Findings:
Ultrasonographic images of the pyloric region demonstrate characteristic thickening of the pyloric muscle of 4.6 mm, and pyloric channel length of 20 mm.
Diagnosis:
Discussion:
Age at presentation: majority between 2-8 weeks of life. Presented with nonbilious projectile vomiting with progression over a period of several weeks after birth (15-20%). Palpable olive-shaped mass (80% sensitive in experienced hands). Males > females (radio of approximately 5:1). Uncommon in blacks. The value of imaging studies to assist in the diagnosis of pyloric stenosis has, however, been clearly elucidated. Ultrasound is presently the imaging modality-of-choice at most institutions. The currently accepted parameters (longitudinal images) necessary for diagnosis are as follows:
- Pyloric muscle thickness: > 4 mm.
- Pyloric channel length: > 17 mm.
- Pyloric muscle length: > 19 mm
References:
- Haller JO, and Cohen HL. Hypertrophic pyloric stenosis: Diagnosis using US. Radiology 161:335-339, 1986.
- Hilton, SvW. The Child with Vomiting. Practical Pediatric Imaging,
2nd edition, pages 297-333. SvW Hilton and DK Edwards, eds. WB Saunders Company, 1994. - Teele RL and Smith EH. Ultrasound in the diagnosis of idiopathic hypertrophic pyloric stenosis. N Engl J Med 296: 1149-1150, 1977.
