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Oesophageal atresia with trache-oesophageal fistula

Case contributed by Dr Hani Salam

ET tube is above the carina.  Both the UAC and UVC lines are too high, the UAC tip is projected over the left common carotid and the UVC tip at T6, over the right atrium.

The baby is preterm, as indicated by reduced subcutaneous fat and lack of humeral epiphysis ossification.

The lungs are of low volume with bilateral, generalised increased opacification, consistent with RDS.  

Within the upper mediastinum is a prominent gas-filled structure in the midline.  Features are of oesophageal atrsia, but since there is gas within the stomach and small bowel, there must be connection between the tracheal and distal oesophagus.

A coned view of the upper mediastinum was performed.

Coned view of the upper mediastinum.

The upper oesophagus is dilated and filled with gas.  There is an abrupt transition between the dilated gas-filled upper oesophagus and the mid-oesophagus which is not visible.

As demonstrated on the complete film, the ET is above the carina and the UAC is in an aortic-arch-branch vessel.

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