Excessive Bright Echoes Sign for Hypertrophic Pyloric Stenosis Suggest the Diagnosis: Gastric Pneumatosis and Portal Venous Gas in Infants Suggest HPS

Harris L. Cohen, P. Blake Chism, Ina Radtke

Research output: Contribution to journalArticlepeer-review

Abstract

We describe a new finding, the "excessive bright echoes" sign, for the diagnosis of hypertrophic pyloric stenosis (HPS). Portal venous gas and gastric wall pneumatosis were noted in 4 vomiting infants proven to have HPS. Portal venous gas can be concerning for ischemic bowel. Gastric wall pneumatosis can be seen in association with necrotizing enterocolitis and has been associated with increased gastric pressure from severe, usually proximal, bowel obstruction. Our HPS cases had prominent bright punctate echoes on sonography of the liver, portal vein lumen, and gastric wall. Knowledge of this excessive bright echoes sign suggests the need for sonography of the antropyloric area. One should consider HPS as a differential diagnostic possibility when the combination of bright echoes within the liver parenchyma, consistent with portal venous gas, and bright echoes in the gastric wall, consistent with gastric pneumatosis, are seen.

Original languageEnglish (US)
Pages (from-to)1059-1063
Number of pages5
JournalJournal of Ultrasound in Medicine
Volume36
Issue number5
DOIs
StatePublished - May 2017

Keywords

  • excessive bright echoes sign
  • gastric wall pneumatosis
  • hypertrophic pyloric stenosis
  • pediatric ultrasound
  • pediatrics
  • portal venous gas
  • sonography

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging

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