Three weeks old male infant with vomiting after br

 

Images

Doctor's Information

Name :  Mehdi
Family :Bitarafan
Email :  ----------------
Resident :  Hussein Soleiman Tabar

 

Patient's Information

Gender :  Male
Age :  0

 

Case Section

Pediatric Radiology

 

Clinical Summary

weeks old male infant with vomiting after breast feeding and failure to weight gain.

 

 

Imaging Procedures and Findings

In image 1 the stomach is filled with contrast and pyloric canal is elongated and narrowed (the so called ??string sign�). Image 2 shows reflux of barium through G-E junction which is due to increased intragastric pressure.

 

Discussion

The etiology of HPS is unknown. It presents with projectile vomiting. Associated clinical findings include weight loss, dehydration, and hypochloremic alkalosis. The age of presentation is typically between 4 and 6 weeks. There is often a family history. It tends to occur in first born male infants (male-to-female ratio 3:1). No imaging is required if an experienced clinician can reliably palpate the hypertrophied pylorus. US has proven to be an accurate method for the diagnosis of HPS and has replaced the barium meal in vomiting infants . Occasionally, if US fails to confirm the diagnosis of HPS or if gastroesophageal reflux (GOR) is the likely diagnosis, a barium meal is performed. The pyloric canal is elongated (??stringâ?? sign) and indents the distal antrum to produce the ??titâ?? deformity. Gastric emptying is delayed and GOR is usually present due to gastric outlet obstruction. Treatment is by pyloromyotomy

 

Final Diagnosis

Hypertrophic pyloric stenosis

 

References

Adam: Grainger & Allison's Diagnostic Radiology, 5th ed

 

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