Hypertrophic Pyloric Stenosis vs. Adrenogenital Syndrome
Left picture: The suspected clinical diagnosis is a hypertrophic pyloric stenosis because tentative feeding leads to a visible hyperperistalsis of the stomach which is a pathognomonic sign; the hyperperistalsis is recognizable in the corresponding picture by a swelling below the left costal margin, and an additonal swelling in the middle upper belly. In addition, a pyloric tumor is palpable. Right picture: Here, the suspected clinical diagnosis is a complicated adrenogenital syndrome in a girl with virilization of the external genitals (stage IV according to Prader), and not an anterior to middle type of hypospadias. Testicles are neither visible nor palpable.
Both children have been vomiting since the transition from the first to the second month, and since the transition from the second to the third week of life, respectively. In both patients skin folds are visible on the arms and legs. Left picture: The young infant is drinking the tea greedily and during feeding a swelling is recognizable in the upper belly. Right picture: In spite of vomiting a micturation can be seen; the scrotum has a strong pigmentation. On elevating the penis an empty scrotum is visible on both sides and the urethral orifice lies proximally to the glans (picture at the bottom on the same side).