Presentation
Respiratory distress, choking and cyanosis during attempted feeding.
Patient Data
The plain film shows the nasogastric tube not passing to the stomach. Instead, it is curling back superiorly. However, bowel gas is present suggesting oesophagal atresia with the presence of a tracheoesophageal fistula.
An opacity in the upper third of the right lung, limited by the horizontal scissure, characterizing involvement of the right upper lobe is noted.
Loading images...
Control:
Curling of the NG tube is seen within the dilated proximal esophagus.
After contrast:
Contrast (diluted non-iodinated) was introduced through the NG tube slowly. Instillation of contrast via the NG tube fills the proximal esophagus with no distal transit. No communication between the proximal oesophagal pouch and airway is seen.
Gas is demonstrated in the stomach and bowel loops across all the images. Given the proximal atresia, this suggests a fistula between the airways and distal esophagus.
Case Discussion
The majority of babies (86%) with esophageal atresia (OA) have a distal tracheo-esophageal fistula. Pure OA (without fistula) is much less common occurring in approximately (6%) of total cases.
Clinical findings
- Respiratory distress
- Aspiration
- Choking
- Drooling
- Difficulty handling secretions
Imaging findings
Prenatal ultrasound - polyhydramnios may be detected.
Chest x-ray - radiolucent, blind-end dilated pouch of the upper esophagus may be seen with failure to pass NG tube into the stomach. The characteristic feature of pure congenital esophageal atresia and no fistula is a gasless abdomen in the presence of esophageal atresia.
Types
The five subtypes of esophageal atresia (Gross and Vogt Classification) are as follows:
- type A: isolated esophageal atresia (8%)
- type B: proximal fistula with distal atresia (1%)
- type C: proximal atresia with distal fistula (85%)
- type D: double fistula with intervening atresia (1%)
- type E: isolated fistula (H-type) (4%)