Journal of Ultrasound in Medicine, Vol 17, Issue 11 705-711, Copyright © 1998 by American Institute of Ultrasound in Medicine
Ultrasonography of pylorospasm: findings may simulate hypertrophic pyloric stenosis
H. L. Cohen, H. L. Zinn, J. O. Haller, P. J. Homel and J. M. Stoane
Department of Radiology, SUNY-Health Science Center at Brooklyn, New York, USA.
We compared sonographic images and measurements of patients diagnosed as
having hypertrophic pyloric stenosis and pylorospasm among infants with
projectile vomiting. Thirty-seven patients with hypertrophic pyloric
stenosis had an unchanged pyloric length (mean, 22.5 mm) and muscle wall
thickness (mean, 5.3 mm). Thirty-four pylorospasm patients had considerable
variability in measurement or image appearance during their studies. Means
of their longest or largest measurements were 14.4 mm for pylorus length
and 3.8 mm for muscle wall thickness. Among these, 53% had muscle wall
thickness of 4 mm or greater and 18% had pyloric length of 18 mm or greater
during some portion of their study. We concluded (after clinical follow-up
study confirmed our ultrasonographic diagnoses) that pylorospasm may mimic
hypertrophic pyloric stenosis for at least a portion of a sonographic
study. Muscle wall thickness or pyloric length measurements may overlap
those accepted as positive for hypertrophic pyloric stenosis. Image or
measurement variability is an important clue for diagnosing pylorospasm.
