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Sonographic diagnosis of hypertrophic pyloric stenosis: preliminary experience
1Department of Radiology, Faculty of Medicine, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia.
Insights
Ultrasound is highly effective for diagnosing infantile hypertrophic pyloric stenosis (HPS). A pyloric muscle thickness (PMT) of 3 mm or more accurately identifies HPS, with higher measurements in affected infants.
Area of Science:
- Pediatric Radiology
- Gastroenterology
- Diagnostic Imaging
Background:
- Infantile hypertrophic pyloric stenosis (HPS) is a common surgical emergency in infants.
- Accurate and timely diagnosis is crucial for effective management.
- Ultrasound has emerged as a primary diagnostic tool for HPS.
Purpose of the Study:
- To evaluate the diagnostic value of ultrasound measurements in suspected infantile hypertrophic pyloric stenosis (HPS).
- To establish reliable ultrasound criteria for HPS diagnosis.
- To assess the utility of pyloric muscle thickness (PMT), pyloric diameter (PD), and pyloric length (PL) in differentiating HPS.
Main Methods:
- A retrospective study analyzing ultrasound data over three years at a tertiary referral hospital.
- Measurements included pyloric muscle thickness (PMT), pyloric diameter (PD), and pyloric length (PL).
- Comparison of measurements between infants with surgically confirmed HPS and those without.
Main Results:
- Ultrasound correctly diagnosed all 39 surgically confirmed cases of HPS (36 males, 3 females).
- Significant differences in mean PMT (4.46 vs 1.81 mm), PL (19.1 vs 11.55 mm), and PD (14.05 vs 8.4 mm) were observed between HPS and non-HPS groups (p < 0.05).
- A PMT of ≥3 mm demonstrated 100% sensitivity and specificity for HPS, with no cases of HPS having PMT < 3 mm.
Conclusions:
- Ultrasound is a highly sensitive and specific diagnostic tool for infantile hypertrophic pyloric stenosis (HPS).
- A pyloric muscle thickness (PMT) of 3 mm or greater is a reliable cutoff for diagnosing HPS.
- Upper gastrointestinal series (UGIS) can be reserved for ambiguous cases with PMT between 2-3 mm.
Abstract:
The value of ultrasound diagnosis for suspicion of infantile hypertrophic pyloric stenosis (HPS) was assessed in three consecutive years using ultrasound measurement of pyloric muscle thickness (PMT), pyloric diameter (PD) and pyloric length (PL) in Tikur Anbessa Hospital which is a tertiary referral and teaching hospital. Among all patients 39 patients (36 males and 3 females) had Infantile Hypertrophic Pyloric Stenosis confirmed by surgery, with male to female ratio of 12:1. Ultrasound correctly diagnosed all of the cases. Sixty- six patients were negative by Ultrasound, Barium meal studies and clinical follow up. The mean Pyloric Muscle Thickness (4.46 Vs 1.81), Pyloric Length (19.1 Vs 11.55) and Pyloric Diameter (14.05 Vs 8.4) between patients with and with out pyloric stenosis were significantly different (p < 0.05). A PMT of 3 mm and above was observed in all cases of HPS, and was never observed in the absence of HPS (100% sensitivity and specificity). A pyloric muscle thickness of 3 mm and above is recommended as a diagnostic cutoff and upper gastrointestinal series (UGIS) can be reserved for those who might fall in the grey zone (i.e. PMT of 2-3 mm).