Milla Sarah,  Cantu Cera,  Richer Edward,  Braithwaite Kiery,  Linam Leann,  Riedesel Erica,  Loewen Jonathan,  Simoneaux Stephen

Final Pr. ID: Poster #: SCI-013

Idiopathic thickening of the pyloric muscle can occur in young infants, causing projectile vomiting, electrolyte abnormalities, and necessity for surgical intervention to relieve the gastric outlet obstruction. Case reports have been published describing infants with HPS who also have portal venous gas (PVG) visualized within the liver. The presence of PVG in other clinical scenarios often indicates a severe and potentially life threatening bowel condition. The purpose of this study was to determine the incidence of infants with hypertrophic pyloric stenosis (HPS) and concurrent portal venous gas (PVG), as well as whether there are unique clinical features or different outcomes in the HPS patients with PVG versus without PVG. Read More

Authors:  Milla Sarah , Cantu Cera , Richer Edward , Braithwaite Kiery , Linam Leann , Riedesel Erica , Loewen Jonathan , Simoneaux Stephen

Keywords:  pyloric stenosis, portal venous gas, pneumatosis

Cielma Tara,  Bandarkar Anjum,  Adeyiga Adebunmi

Final Pr. ID: Poster #: EDU-001 (R)

Background: Infantile hypertrophic pyloric stenosis (IHPS) is a condition affecting young infants in which the circular muscle layer of pylorus becomes thickened, leading to narrowing and elongation of the pyloric channel. The pyloric mucosa becomes redundant and appears hypertrophic. On ultrasound, the thickened pylorus is often seen adjacent to the gallbladder and anteromedial to the right kidney. Infants with IHPS are asymptomatic at birth but, in the first few weeks of life, develop nonbilious forceful vomiting described as “projectile emesis” and present with partial gastric outlet obstruction. Surgical pyloromyotomy is curative.
Standard sonographic criteria include measurement of pyloric muscle >3 mm and elongation of pyloric canal >14 mm. Normal pyloric muscle thickness measures <2 mm. When pyloric muscle thickness measures between 2-3 mm, the exam is called as equivocal or borderline. Factors leading to equivocal exam may include incorrect technique that involves over measuring the pyloric muscle thickness, obliquely oriented section of pylorus and transient pylorospasm.
Purpose: The goals of this exhibit are-
1. To review the sonographic anatomy of normal and abnormal pylorus.
2. To illustrate our technical approach to diagnose IHPS with specific attention on how to accurately measure the muscle thickness and channel length.
3. To describe tips and tricks to minimize equivocal exams. Read More

Authors:  Cielma Tara , Bandarkar Anjum , Adeyiga Adebunmi

Keywords:  Infantile hypertrophic pyloric stenosis, ultrasound, muscularis externa

Richer Edward,  Sanchez Ramon

Final Pr. ID: Poster #: SCI-083

Hypertrophic pyloric stenosis (HPS) is a frequent cause of vomiting in young infants, with an incidence of 1.5 – 4 per 1000 live births, depending on demographic group. The gold standard diagnostic test is abdominal ultrasound targeting the pylorus, and the measurement thresholds for determining an abnormal pylorus are well established. The objective of this study was to assess whether visual, subjective assessment of the pylorus was as accurate in diagnosing HPS as traditional formal measurements.


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Authors:  Richer Edward , Sanchez Ramon

Keywords:  Pyloric stenosis, Ultrasound, Vomiting

Ocal Selin,  Lee Jason,  Alizadeh Houman

Final Pr. ID: Poster #: CR-019

This case elucidates a 20mo male with history of chronic granulomatous disease (CGD) who presented with PO intolerance, recurrent emesis, fussiness, and abdominal pain. The patient was diagnosed with CGD at age 11mo after developing upper extremity cellulitis from Serratia marescens. Just 1 month before this presentation, he underwent colonoscopy/endoscopy for persistent anorexia and fussiness after clean-out for severe constipation and was found with ulcerative pancolitis. Initiation of vendolizumab was recommended; just a few days before his first dose, he developed increased vomiting, lethargy, and PO refusal. Ten days after symptom onset (5 days after first venolizumab dose) he presented to the emergency department. Initial abdominal radiograph was largely unrevealing with clinical suspicion for constipation. However, subsequent upper GI series revealed a diffusely narrowed and elongated pyloric channel with mild delay in gastric emptying, suspicious for pyloric stenosis. Follow-up ultrasound depicted increased pyloric length with mucosal and muscularis thickening consistent with pyloric stenosis in the setting of CGD. An ensuing CT of the abdomen demonstrated segmental circumferential proximal jejunal wall thickening compatible with chronic granulomatous disease enteropathy. Pyloric stenosis, which typically presents in the first 2 months of life, is an unusual finding in a child of age 20mo. Though pulmonary infections are the most commonly affected organ system in CGD, the gastrointestinal (GI) manifestations—beyond just hepatic abscesses, which occur in 25-50% of patients—are infrequently discussed. The patient presented here exhibits predominantly GI-related effects. Granulomatous inflammation can affect any part of the GI tract and may mimic Crohn's disease via bowel wall thickening, luminal narrowing, fistulation, or mucosal cobblestone/skip lesions. Gastric antral wall thickening is estimated in 16% of CGD patients, and more commonly reported upper GI study findings in patients with CGD include delayed gastric emptying, circumferential antral narrowing, gastric fold thickening, or esophageal strictures with dysmotility. Though gastric outlet obstruction from antral or diffuse gastric wall thickening has been described, there are no other prior reports of pyloric stenosis due to CGD. From this case, we posit that CGD should be considered as a causative etiology for older infants/children with new radiological findings of pyloric stenosis. Read More

Authors:  Ocal Selin , Lee Jason , Alizadeh Houman

Keywords:  Pyloric Stenosis, Abdominal Imaging, Upper GI Series

Fenlon Edward

Final Pr. ID: Poster #: EDU-007

Hypertrophic pyloric stenosis (HPS) is a common surgical condition in infants characterized by idiopathic thickening of the gastric pyloric musculature that results in progressive gastric outlet obstruction and non-bilious emesis in infants between the ages of 2 weeks and 3 months. Ultrasound is the best imaging modality in the diagnosis of HPS as it allows for clear delineation of the thickened pyloric muscle and elongated pyloric channel, as well shows associated findings including gastric distention and lack of normal gastric emptying. To the untrained eye however, lack of knowledge of normal anatomy complicated by intermittent antral contraction may make it difficult to confidently exclude HPS. Several fun and helpful radiologic signs have been created to help radiologists and especially radiology trainees recognize the ultrasound findings of HPS (e.g. antral nipple sign and cervix sign). This poster discusses a new radiologic sign called the "eating duck sign" that can be helpful in distinguishing the normal gastric pylorus. In this sign, the distal stomach and antrum appear as the body and head of the duck, the normal gastric pylorus appears as the bill of the duck, and the duodenal bulb appears as the turnip or beet shaped snack of the duck. Read More

Authors:  Fenlon Edward

Keywords:  Hypertrophic Pyloric Stenoisis, Pyloric Stenosis, Radiologic Sign