Pyloric stenosis other imaging findings: Difference between revisions

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==Overview==
== Overview ==
The pyloric canal is outlined by a string of contrast material coursing through the mucosal interstices, termed the '''[[string sign]]'''; or by several linear tracts of contrast material separated by the intervening [[Mucous membrane|mucosa]]. The latter is termed the '''double-track sign'''. This sign demonstrates the intervening redundant [[Mucous membrane|mucosa]] outlined as a filling defect by the contrast material.
[[Upper gastrointestinal series]] ([[barium meal]]) may be helpful in the diagnosis of infantile pyloric stenosis. Findings on an [[upper gastrointestinal series]] suggestive of infantile pyloric stenosis include [[delayed gastric emptying]], [[string sign]], and shoulder sign.


[[Fluoroscopy|Fluoroscopic]] observations include vigorous active peristalsis resembling a caterpillar and coming to an abrupt stop at the [[pyloric antrum]], outlining the external thickened [[muscle]] as an extrinsic impression, termed the '''[[shoulder]] sign'''.
== Other Imaging Findings ==
 
*[[Upper gastrointestinal series]] ([[barium meal]]) may be helpful in the diagnosis of infantile pyloric stenosis.<ref name="pmid21966616">{{cite journal| author=Herliczek TW, Raghavan D, McCarten K, Wallach M| title=Sonographic upper gastrointestinal series in the vomiting infant: how we do it. | journal=J Clin Imaging Sci | year= 2011 | volume= 1 | issue= | pages= 19 | pmid=21966616 | doi=10.4103/2156-7514.78528 | pmc=3177420 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21966616  }} </ref>
Luminal [[barium]] may be transiently trapped between the peristaltic wave and the [[muscle]], and this is termed the '''[[tit]] sign'''
*Findings on an [[upper gastrointestinal series]] suggestive of infantile pyloric stenosis include:<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>
 
** [[Delayed gastric emptying]]
==Other Imaging Findings==
**[[String sign]]: Elongated [[pylorus]] with a narrow [[lumen]]<ref name="pmid3550137">{{cite journal| author=Cohen HL, Schechter S, Mestel AL, Eaton DH, Haller JO| title=Ultrasonic "double track" sign in hypertrophic pyloric stenosis. | journal=J Ultrasound Med | year= 1987 | volume= 6 | issue= 3 | pages= 139-43 | pmid=3550137 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3550137  }} </ref>
===Upper GI Series===
**Shoulder sign: Indentation of the [[pylorus]] into the contrast-filled [[antrum]]<ref name="pmid1523050">{{cite journal| author=Levine D, Edwards DK| title=The olive on end: a useful variant of the "shoulder" sign in the barium X-ray diagnosis of idiopathic hypertrophic pyloric stenosis. | journal=Pediatr Radiol | year= 1992 | volume= 22 | issue= 4 | pages= 275-6 | pmid=1523050 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1523050  }} </ref>
 
*The pyloric [[Canal (anatomy)|canal]] is outlined by a string of contrast material coursing through the mucosal interstices, termed the '''string sign'''; or by several linear tracts of contrast material separated by the intervening [[Mucous membrane|mucosa]]. The latter is termed the '''double-track sign'''. This sign demonstrates the intervening redundant [[Mucous membrane|mucosa]] outlined as a filling defect by the contrast material.
*[[Upper gastrointestinal series|Upper GI series]] is performed with the infant in the right anterior oblique position, to facilitate gastric emptying.
*[[Fluoroscopy|Fluoroscopic]] observations include vigorous active peristalsis resembling a caterpillar and coming to an abrupt stop at the pyloric antrum, outlining the external thickened muscle as an extrinsic impression, termed the '''[[shoulder]] sign'''.  
*Luminal barium may be transiently trapped between the peristaltic wave and the [[muscle]], and this is termed the '''tit sign'''.
*Eventual success of gastric peristaltic activity will propel contrast material through the pyloric mucosal interstices, with the appearance as either the string sign or the double-track sign, although at times more than one layer of contrast material may be appreciated in the mucosal filling defect.
 
(Images courtesy of RadsWiki)
 
<gallery>
Image:Hypertrophic-pyloric-stenosis-001.jpg
</gallery>
 
===Nuclear Scanning===
Nuclear medicine scanning is not routinely used for hypertrophic pyloric stenosis; however, possible findings include delayed gastric emptying.


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
 
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Latest revision as of 21:47, 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

Upper gastrointestinal series (barium meal) may be helpful in the diagnosis of infantile pyloric stenosis. Findings on an upper gastrointestinal series suggestive of infantile pyloric stenosis include delayed gastric emptying, string sign, and shoulder sign.

Other Imaging Findings

References

  1. ↑ Herliczek TW, Raghavan D, McCarten K, Wallach M (2011). "Sonographic upper gastrointestinal series in the vomiting infant: how we do it". J Clin Imaging Sci. 1: 19. doi:10.4103/2156-7514.78528. PMC 3177420. PMID 21966616.
  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. ↑ Cohen HL, Schechter S, Mestel AL, Eaton DH, Haller JO (1987). "Ultrasonic "double track" sign in hypertrophic pyloric stenosis". J Ultrasound Med. 6 (3): 139–43. PMID 3550137.
  4. ↑ Levine D, Edwards DK (1992). "The olive on end: a useful variant of the "shoulder" sign in the barium X-ray diagnosis of idiopathic hypertrophic pyloric stenosis". Pediatr Radiol. 22 (4): 275–6. PMID 1523050.

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