Pyloric stenosis other imaging findings

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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

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 mucosa. The latter is termed the double-track sign. This sign demonstrates the intervening redundant mucosa outlined as a filling defect by the contrast material.

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

Other Imaging Findings

Upper GI Series

• 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 mucosa. The latter is termed the double-track sign. This sign demonstrates the intervening redundant mucosa outlined as a filling defect by the contrast material.
• UGI is performed with the infant in the right anterior oblique position, to facilitate gastric emptying.
• 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)

• 

Nuclear Scanning

• Nuclear medicine scanning is not routinely used for hypertrophic pyloric stenosis; however, possible findings include delayed gastric emptying.