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

Meeting name: SPR 2017 Annual Meeting & Categorical Course , 2017

Authors: Cielma Tara, Bandarkar Anjum, Adeyiga Adebunmi

Keywords: Infantile hypertrophic pyloric stenosis, ultrasound, muscularis externa

Background: Hemophilia is a rare X-linked recessive bleeding disorder characterized by the absence of one of the coagulation factors including factor VIII in hemophilia A and factor IX in hemophilia B. Amongst the complications, muscle hemorrhage is the second most common type of hemorrhage in hemophilia, second only to hemarthrosis. Bleeding may be precipitated by trauma or fractures or may be spontaneous. Hemorrhage into the large muscle groups of the upper and lower extremities, can cause tissue compartment syndrome, nerve compression, and potential tissue death. A child with hemophilia and muscle hemorrhage may present with focal swelling, pain, or refusal to use the affected body part. Early recognition and treatment of muscle hemorrhages can prevent compartment syndrome and longterm complications, reduce pain, and allow a quick return to normal function and activity. Aims: 1. To describe utility of rapid ultrasound in detecting muscle hemorrhages in children with hemophilia. 2. To illustrate sonographic appearances of muscle hemorrhages in various locations in the body. Read More

Meeting name: SPR 2017 Annual Meeting & Categorical Course , 2017

Authors: Bandarkar Anjum, Cielma Tara, Holley Danyelle, Adeyiga Adebunmi

Keywords: Hemophilia, Muscle hemorrhage, Hematoma