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Age: 7 weeks (term delivery)

Sex: Female

Indication: Projectile vomiting

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Case #13


Findings

  • Pyloric channel measures approximately 15 mm in length (it was over-measured at 22 mm)
  • Single wall muscle thickness measures approximately 3 mm (it was over-measured at 4 mm several times)
  • Opening of the pyloric channel during real-time imaging with passage of fluid into the duodenum


Diagnosis

Negative pyloric ultrasound

Sample Report

Borderline increased pyloric channel length measuring approximately 15 mm and borderline increased pyloric single wall muscle thickness measuring 3 mm with relaxation of the pylorus and passage of fluid into the duodenum during real-time observation. These findings are not currently consistent with hypertrophic pyloric stenosis, though repeat imaging should be considered if symptoms persist or worsen.


Discussion

  • Pyloric ultrasound is very technically challenging to perform. Watch out for measurements that may be falsely reassuring or alarming. It is important to discuss these cases with the sonographer to understand their level of comfort with the study and their confidence with their measurements
  • The pylorus may spasm during imaging, preventing passage of fluid into the duodenum – this is why it is important to intermittently watch the stomach over 30 minutes to look for relaxation. Hypertrophic pyloric stenosis will not relax


Images

Over-measured pyloric channel length, which was measured at 22 cm, but in actuality measures closer to 15 cm.

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