Peds-Gastrointestinal

Pyloric Stenosis

4 w/o male with forceful vomiting with each feed. Clip fans through hypertrophic pylorus measuring 14mm in diameter and channel length 24mm. It also shows a fluid filled stomach and the "antral nipple sign" - outpouching of pyloric tissue into antrum.

The "Pi" π = 3.1415 mnemonic for ballpark measurement cut-offs.

>3mm diameter of single muscular wall

>14mm transverse diameter of pylorus

>15mm channel length

Lilly Bellman, MD - PEM /US fellow Harbor-UCLA

4-week-old, vomiting intermittently for 2 weeks, seen PCP 3 days ago, reassured. Revisit today and PCP concerned for pyloric stenosis, so referred to ED. Exam in ED reassuring for well-appearing neonate.

In ED, POCUS completed revealing hypertrophic pyloric stenosis. Pylorus muscle hypertrophied and thickened in both transverse and logitudinal view. Transverse view demonstrates the classic target sign seen in pyloric stenosis.

Dr. Sathya Subramaniam, Pediatric EM Fellow - Kings County/SUNY Downstate

3 week old with projectile vomiting, POCUS showed positive astral nipple sign which is a highly specific finding for pyloric stenosis - the redundant pyloric mucosa protrudes into the gastric antrum. The measurements show increased pyloric muscle thickness (>3mm) and increased pyloric longitudinal measurement (>15 - 17 mm)

Measurements can be remembered using "Pi Rule"

- Pyloric muscle thickness, i.e. diame­ter of a single muscular wall on a transverse image >3 mm

- Pyloric transverse diameter >14 mm

- Pyloric longitudinal measurement >15 - 17 mm

Contributed by:

Dimitri Livshits DO, Ultrasound Fellow; Jane Belyavskaya MD, Ultrasound Fellow; Chris Hanuscin MD, Ultrasound Division Director (Kings County/SUNY Downstate)

Roughly 1m male with projectile emesis. POCUS demonstrated elongated and thickened pylorus with absence of trans-pyloric flow.

Contributor: Matthew Moake, MD PhD

2+ weeks projectile vomiting. Extreme lab abnormalities including Cl 67. CG4: 7.57/67/34/60, base excess >30, lactate 3.23. The pyloric channel is elongated, thickened, and has an absence of trans-pyloric flow.

Contributor: Matthew Moake, MD PhD

5 wk old male with projectile vomiting. Clips show hypertrophic pyloric stenosis in long axis.

Contributor: Paul Khalil, MD Nicklaus Children's Hospital @khalil3paul

5 wk old male with projectile vomiting. Clips show hypertrophic pyloric stenosis in short axis.

Contributor: Paul Khalil, MD Nicklaus Children's Hospital @khalil3paul

5 wk old male with projectile vomiting. Clips show hypertrophic pyloric stenosis in short axis.

Contributor: Paul Khalil, MD Nicklaus Children's Hospital @khalil3paul