Presentation
A newborn baby with increased secretions and dyspnea. Failure to pass nasogastric tube into stomach.
Patient Data
A control image shows the NG tube within the upper esophagus, which is distended and gas-filled. There is also gas within the stomach and bowel loops. This suggests a communication/fistula between the airways and the distal esophagus.
On the second image, instillation of contrast via the NG tube fills the proximal esophagus with no distal transit.
The third image shows the result of aspiration of barium from the distended esophagus, opacifying the bronchial tree.
Annotated images:
- yellow arrow: nasogsatric tube (curled in upper esophagus)
- red arrow: distended upper oseophagus.
These are features of esophageal atresia.
- black arrows: opacification of the bronchial tree from the larynx down, secondary to contrast aspiration
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 (tracheo-esophageal fistula).
Case Discussion
A congenital tracheo-esophageal fistula (TOF) is a communication between the trachea and esophagus.
The diagnosis is usually made in the neonatal period, as they experience feeding difficulties and respiratory compromise due to repeated aspiration.
Plain radiography is usually sufficient for diagnosis but barium study is the gold standard technique for demonstrating and typing TOF.
With proximal atresia and a probable tracheal/distal esophageal fistula, this would be a type C TOF.
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