Infantile Hypertrophic

Pyloric Stenosis
Justin Charles MS3
Radiology Clerkship
Case Presentation

A 4-week-old full-term boy presents with nonbloody,

nonbilious, projectile vomiting after every feed for the past
week. Despite this, he has an excellent appetite. On physical
exam, the infant is awake and alert, with decreased skin turgor,
delayed capillary refill and sunken anterior fontanelle.
Peristaltic waves are seen over the upper abdomen and an
olive-shaped mass is palpated in the right upper quadrant

Likely Diagnosis?
Case Presentation

A 4-week-old full-term boy presents with nonbloody,

nonbilious, projectile vomiting after every feed for the past
week. Despite this, he has an excellent appetite. On physical
exam, the infant is awake and alert, with decreased skin
turgor, delayed capillary refill and sunken anterior
fontanelle. Peristaltic waves are seen over the upper
abdomen and an olive-shaped mass is palpated in the right
upper quadrant

Likely Diagnosis?
Infantile Hypertrophic Pyloric Stenosis
Disease information
Pathophysiology
Hypertrophy of pyloric sphincter gastric outlet
obstruction forceful vomiting
Nonbilious because obstruction is before 2nd part of
duodenum
Epidemiology
2 to 3.5 per 1000 live births
Risk factors
First-born male
Erythromycin
Bottle Feeding
Treatment
Correct any dehydration and electrolyte abnormalities
Pyloromyotomy
Diagnostic Imaging
Ultrasonography Upper GI contrast study

Cost Variable Variable

Radiation exposure None Present

Demonstrates IHPS, other

Can only demonstrate IHPS if
Diagnostic differentiation causes of obstruction, and
present
anatomic variation

Risk of aspiration None Present but small

Dependence on skill of
High Low
technician

Adapted from:
1. Mandell GA, Wolfson PJ, Adkins ES, et al, Pediatrics 1999; 103:1198.
2. Hulka F, Campbell JR, Harrison MW, Campbell TJ, J Pediatric Surg 1997; 32:1604.
3. Godbole P, Sprigg A, Dickson JA, Lin PC, Arch Dis Child 1996; 75:335.
Ultrasound (Gold Standard)
Diagnostic Criteria
pyloric muscle
thickness
>3 mm
pyloric transverse
diameter:
14 mm
length:
>15 mm
Mnemonic:
= 3.1415
Other Ultrasound Findings
Target Sign
hypertrophied hypoechoic
muscle surrounding
echogenic mucosa

Cervix Sign
indentation of the pylorus
into the fluid-filled
antrum

https://radiopaedia.org/articles/pyloric-stenosis
Upper GI Series: String Sign

String-like appearance of a
contrast-filled bowel loop
caused by severe narrowing
of a bowel loop

Case courtesy of baltimore kely mendez, Radiopaedia.org, rID: 21002

Upper GI Series: Mushroom Sign

Impression made by the

hypertrophic pylorus on
the duodenal cap

Case courtesy of baltimore kely mendez, Radiopaedia.org, rID: 21002

Upper GI Series: Caterpillar Sign

Visible peristaltic waves

Case courtesy of baltimore kely mendez, Radiopaedia.org, rID: 21002

Thanks for Listening!