Radiographs may show a distended stomach and decreased bowel gas distally. This 5-week-old boy presented with progressively worsening vomiting, which is now projectile. The supine radiograph of the abdomen shows mild distention of the stomach. There is gas in the rest of the gastrointestinal tract, and the bowel pattern is nonobstructive.
Ultrasound shows a hypertrophied muscle and decreased gastric emptying on real-time imaging. HPS is generally considered when the pyloric single wall thickness is greater than 3 mm and the pyloric channel length is greater than 15 mm.
Overlying gas may obscure the pylorus, and the baby is best evaluated in the right lateral decubitus position. Administration of fluid in this position can also help when measurements are not 100% convincing ("normal" values vary among sources and affect sensitivity and specificity). If fluid is seen to pass to the duodenal bulb, HPS becomes less likely.
An abdominal ultrasound in the same patient showed abnormal thickening of pylorus up to 4.2 mm and abnormal elongation of the antropyloric region of at least 1.9 cm. A small amount of pedialyte was given orally, but there was no significant passage of fluid through the pylorus.
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