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:

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)

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Nuclear Scanning

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