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Joseph Junewick, MD FACR
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Pyloric Stenosis and Portal Venous Gas

Case Detail

Anatomy: Gastrointestinal
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Developmental or Congenital
Created: over 4 years ago
Updated: over 4 years ago
Tags: PEDS
Modality/Study Types: US
Activities:
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History

11 day old male with projectile vomiting for 1 day.


Case Images


Diagnosis

Pyloric Stenosis and Portal Venous Gas

Findings

US – Pylyoric muscle measures 4 mm and pyloric channel measures 17 mm. The pyloric mucosa is hyperplastic. The stomach is decompressed. Numerous punctate portal hyperechogenicities are present.

Discussion

Portal venous gas is typically seen with necrotizing entertocolits but can be seen with Hirschprung’s disease, collagen vascular disease, intestinal obstruction and massive bowel dilation. Portal venous gases have been shown to induce rouleaux formation (red blood cell aggregates). The combination of gas bubbles and blood cell aggregates likely account for the echogenic appearance. Distention and forceful vomiting probably allow venolymphatic escape of gastric gas. Association of pyloric stenosis and portal venous gas is benign and should not deter surgery.

Reference

Sarti J, Kennedy A. Portal venous gas in hypertrophic pyloric stenosis. J Pediatr Surg (2006); 41:1935-1936.

Sorantin E, Fotter R, Schimpl G. Reversible portal venous gas in hypertrophic pyloric stenosis: Detection by ultrasound. J Ultrasound Med (1995);14:699-701.

Contributor

John Quick, MD



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