Immediate Emergency Department Diagnosis of Pyloric Stenosis with Point-of-care Ultrasound

A 15-day-old male who was born at term presented with non-bilious projectile vomiting. He was nontoxic and his abdomen was benign without masses. Point-of-care ultrasound (POCUS) showed hypertrophic pyloric stenosis (HPS). Typical findings include target sign; pyloric muscle thickness greater than three millimeters (mm); channel length greater than 15-18 mm; and lack of gastric emptying. The patient was admitted; consultative ultrasound (US) was negative, but repeated 48 hours later for persistent vomiting. This second US was interpreted as HPS, which was confirmed surgically. Pyloromyotomy was successful. Few reports describe POCUS by general emergency physicians to diagnose HPS. Here, we emphasize the value in repeat US for patients with persistent symptoms.