Pyloric stenosis ultrasound: Difference between revisions

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{{Pyloric stenosis}}
{{Pyloric stenosis}}
{{CMG}} {{AE}} {{MMJ}}
{{CMG}}; {{AE}} {{MMJ}}


==Overview==
==Overview==
[[Ultrasonography]] demonstrates the thickened prepyloric [[antrum]] bridging the [[duodenal bulb]] and distended [[stomach]] and is the best [[imaging]] for [[diagnosis]] of infantile pyloric stenosis.
[[Ultrasonography]] is the modality of choice for the [[diagnosis]] of infantile pyloric stenosis. The thickened pre-pyloric [[antrum]] bridging the duodenal bulb and distended [[stomach]] could be seen in the [[ultrasound]] of patients with infantile pyloric stenosis. Demonstration of the pylorus is achieved by identifying the [[duodenal]] cap, distended [[stomach]], and intervening pyloric channel. In patients with pyloric stenosis, the variable [[Hypertrophy (medical)|hypertrophy]] of the smooth muscle and crowded intervening mucosa which is thickened to a variable degree, and protrudes into the distended portion of the [[antrum]] '''(nipple sign''')  may be observed on [[ultrasonography]].
 
==Ultrasound==
==Ultrasound==
*[[Ultrasonography]] demonstrates the thickened prepyloric antrum bridging the duodenal bulb and distended [[stomach]].  
[[Ultrasonography]] is the modality of choice for the [[diagnosis]] of infantile pyloric stenosis.<ref name="pmid22696086">{{cite journal| author=Costa Dias S, Swinson S, Torrão H, Gonçalves L, Kurochka S, Vaz CP et al.| title=Hypertrophic pyloric stenosis: tips and tricks for ultrasound diagnosis. | journal=Insights Imaging | year= 2012 | volume= 3 | issue= 3 | pages= 247-50 | pmid=22696086 | doi=10.1007/s13244-012-0168-x | pmc=3369120 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22696086  }} </ref>
*Demonstration of the pylorus is achieved by identifying the duodenal cap, distended [[stomach]], and intervening pyloric channel.
*The thickened pre-pyloric [[antrum]] bridging the duodenal bulb and distended [[stomach]] could be seen in the [[ultrasound]] of patients with infantile pyloric stenosis.<ref name="pmid17966373">{{cite journal| author=Roldán-Valadez E, Solórzano-Morales S, Osorio-Peralta S| title=[Imaging diagnosis of infantile hypertrophic pyloric stenosis: report of a case and review of the literature]. | journal=Rev Gastroenterol Mex | year= 2007 | volume= 72 | issue= 2 | pages= 126-32 | pmid=17966373 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17966373  }} </ref>
*In patients with pyloric stenosis, the [[muscle]] is hypertrophied to a variable degree, and the intervening [[mucosa]] is crowded, thickened to a variable degree, and protrudes into the distended portion of the [[antrum]] ('''nipple sign''') and can be seen filling the [[lumen]] on transverse sections.
*Demonstration of the pylorus is achieved by identifying the [[duodenal]] cap, distended [[stomach]], and intervening pyloric channel.
*The length of the hypertrophied canal is variable and may range from '''as little as 14 mm to more than 20 mm'''.  
In patients with pyloric stenosis, the following findings may be observed on ultrasonography:
*The numeric value for the lower limit of [[muscle]] thickness has varied in reports in the literature, ranging '''between 3.0 and 4.5 mm'''.
*Variable [[Hypertrophy (medical)|hypertrophy]] of the [[smooth muscle]]  
*'''The actual numeric value is less important than the overall [[morphology]] of the canal and the real-time observations.'''
*Intervening [[mucosa]] is crowded, thickened to a variable degree, and protrudes into the distended portion of the [[antrum]] '''nipple sign'''<ref name="pmid7602686">{{cite journal| author=Hernanz-Schulman M, Dinauer P, Ambrosino MM, Polk DB, Neblett WW| title=The antral nipple sign of pyloric mucosal prolapse: endoscopic correlation of a new sonographic observation in patients with pyloric stenosis. | journal=J Ultrasound Med | year= 1995 | volume= 14 | issue= 4 | pages= 283-7 | pmid=7602686 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7602686  }} </ref>
*Protruded [[mucosa]] may be seen filling the [[lumen]] on transverse sections.  


(Images courtesy of RadsWiki)
* Hypertrophied hypoechoic muscle surrounding echogenic mucosa may be seen in the ultrasound of patients with infantile pyloric stenosis called '''target sign'''.<ref name="pmid21475495">{{cite journal| author=Hussain M| title=Sonographic Diagnosis of Infantile Hypertrophic Pyloric stenosis- Use of Simultaneous Grey-scale & Colour Doppler Examination. | journal=Int J Health Sci (Qassim) | year= 2008 | volume= 2 | issue= 2 | pages= 134-40 | pmid=21475495 | doi= | pmc=3068743 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21475495  }} </ref>
[[File:Pyloric_stenosis_nipple_sign_GIF.gif|500px|thumb|left|Ultrasonography showing pyloric stenosis nipple sign [https://radiopaedia.org/articles/antral-nipple-sign source:Case courtesy of Dr Laughlin Dawes , Radiopaedia.org, rID: 8142]]]
<br style="clear:left" />


<gallery>
[[File:Hypertrophic-pyloric-stenosis-target sign.jpg|500px|thumb|left|Ultrasonography showing pyloric stenosis target sign [https://radiopaedia.org/cases/51340 source:Case courtesy of Dr Hidayatullah Hamidi, Radiopaedia.org, rID: 51340]]]
Image:Hypertrophic-pyloric-stenosis-002.jpg
<br style="clear:left" />
Image:Hypertrophic-pyloric-stenosis-003.jpg
Image:Hypertrophic-pyloric-stenosis-004.jpg
</gallery>


==References==
==References==
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[[Category:Surgery]]
[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Surgery]]
[[Category:Disease]]
[[Category:Pediatrics]]
[[Category:Up-To-Date]]
[[Category:Radiology]]
]

Latest revision as of 19:42, 11 December 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]

Overview

Ultrasonography is the modality of choice for the diagnosis of infantile pyloric stenosis. The thickened pre-pyloric antrum bridging the duodenal bulb and distended stomach could be seen in the ultrasound of patients with infantile pyloric stenosis. Demonstration of the pylorus is achieved by identifying the duodenal cap, distended stomach, and intervening pyloric channel. In patients with pyloric stenosis, the variable hypertrophy of the smooth muscle and crowded intervening mucosa which is thickened to a variable degree, and protrudes into the distended portion of the antrum (nipple sign) may be observed on ultrasonography.

Ultrasound

Ultrasonography is the modality of choice for the diagnosis of infantile pyloric stenosis.[1]

  • The thickened pre-pyloric antrum bridging the duodenal bulb and distended stomach could be seen in the ultrasound of patients with infantile pyloric stenosis.[2]
  • Demonstration of the pylorus is achieved by identifying the duodenal cap, distended stomach, and intervening pyloric channel.

In patients with pyloric stenosis, the following findings may be observed on ultrasonography:

  • Hypertrophied hypoechoic muscle surrounding echogenic mucosa may be seen in the ultrasound of patients with infantile pyloric stenosis called target sign.[4]
Ultrasonography showing pyloric stenosis nipple sign source:Case courtesy of Dr Laughlin Dawes , Radiopaedia.org, rID: 8142


Ultrasonography showing pyloric stenosis target sign source:Case courtesy of Dr Hidayatullah Hamidi, Radiopaedia.org, rID: 51340


References

  1. Costa Dias S, Swinson S, Torrão H, Gonçalves L, Kurochka S, Vaz CP; et al. (2012). "Hypertrophic pyloric stenosis: tips and tricks for ultrasound diagnosis". Insights Imaging. 3 (3): 247–50. doi:10.1007/s13244-012-0168-x. PMC 3369120. PMID 22696086.
  2. Roldán-Valadez E, Solórzano-Morales S, Osorio-Peralta S (2007). "[Imaging diagnosis of infantile hypertrophic pyloric stenosis: report of a case and review of the literature]". Rev Gastroenterol Mex. 72 (2): 126–32. PMID 17966373.
  3. Hernanz-Schulman M, Dinauer P, Ambrosino MM, Polk DB, Neblett WW (1995). "The antral nipple sign of pyloric mucosal prolapse: endoscopic correlation of a new sonographic observation in patients with pyloric stenosis". J Ultrasound Med. 14 (4): 283–7. PMID 7602686.
  4. Hussain M (2008). "Sonographic Diagnosis of Infantile Hypertrophic Pyloric stenosis- Use of Simultaneous Grey-scale & Colour Doppler Examination". Int J Health Sci (Qassim). 2 (2): 134–40. PMC 3068743. PMID 21475495.

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