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Antropyloric muscle thickness at US in infants: what is normal?
F N O'Keeffe1, S D Stansberry, L E Swischuk
1Department of Radiology, University of Texas Medical Branch, Galveston 77550.
Insights
Ultrasonography can diagnose pyloric stenosis in infants. Antropyloric muscle thickness under 2 mm is normal, while 3 mm or greater indicates pyloric stenosis.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging
Background:
- Chronic vomiting and regurgitation are common in infants.
- Accurate diagnosis of upper gastrointestinal issues is crucial for infant health.
Purpose of the Study:
- To determine the diagnostic accuracy of antropyloric muscle thickness measured via ultrasonography for pyloric stenosis in infants.
- To establish clear ultrasonographic criteria for normal and abnormal antropyloric muscle thickness.
Main Methods:
- Retrospective review of ultrasonographic (US) images and medical records of 145 infants.
- Measurement of antropyloric muscle thickness in the midlongitudinal plane.
- Categorization of patients into groups based on muscle thickness: group 1 (1-2 mm), group 2 (≥3 mm), and group 3 (2 to <3 mm).
Main Results:
- Group 1 (99 patients) with 1-2 mm thickness was considered normal.
- Group 2 (40 patients) with ≥3 mm thickness was abnormal and diagnostic for pyloric stenosis.
- Group 3 (6 patients) with 2 to <3 mm thickness was abnormal but not specifically diagnostic; 2 of these infants were later diagnosed with pyloric stenosis.
Conclusions:
- Antropyloric muscle thickness <2 mm is unequivocally normal.
- Muscle thickness ≥3 mm is diagnostic for pyloric stenosis.
- Muscle thickness between 2 mm and <3 mm is abnormal and warrants further investigation for pyloric stenosis.
Abstract:
The authors reviewed the ultrasonographic (US) images and medical records of 145 consecutive infants who were seen for evaluation of the upper gastrointestinal tract because of chronic vomiting and/or regurgitation. At US, the antropyloric muscle of each patient was measured in the midlongitudinal plane. On the basis of this measurement, the patients were divided into the following categories: group 1 (1-2 mm; 99 patients), group 2 (greater than or equal to 3 mm; 40 patients), and group 3 (2- less than 3 mm; six patients). Patients in group 1 were considered to have normal antropyloric muscle thickness, those in group 2 had abnormal thickness, and those in group 3 had muscle thickness that was not definitely normal or abnormal. The final clinical diagnoses for all of the infants in the three groups confirmed the authors' initial impressions that antropyloric muscle thickness of less than 2 mm was anatomically normal, muscle measuring 3 mm or greater was abnormal and diagnostic for pyloric stenosis, and muscle from 2 to less than 3 mm was abnormal but not specifically diagnostic for pyloric stenosis. Two of the six patients in group 3 eventually were diagnosed as having pyloric stenosis; thus, the authors believe that only those patients with antropyloric muscle less than 2 mm thick should be considered unequivocably normal.