Presentation
5-week-old who presented projectile post-prandial vomiting
Patient Data
The images above show a marked hypertrophy of the pylorus. The pyloric canal is elongated with a length of up to 20 millimeters (A), the muscle wall is hypoechogenic and thickened, measuring 5 millimeters (B) and the total transverse diameter is 14.5 millimeters (C). Typical signs of hypertrophic pyloric stenosis are also present, such as the antral nipple sign, which consists of redundant pyloric mucosa protruding into the gastric antrum, and the target sign, seen in the transverse image of the pyloric canal due to hypertrophied hypoechoic muscle surrounding the echogenic mucosa. During the whole examination, no stomach content passed through the pyloric canal.
Case Discussion
The case shows the typical ultrasound appearance and measurements of hypertrophic pyloric stenosis. The most accurate measurement to diagnose hypertrophic pyloric stenosis is the diameter of a single muscular wall (hypoechoic component), measuring >3 mm. The patient received surgical treatment (pyloromyotomy) and recovered completely.