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Case of the Week 32 2015

*1 day-old female newborn

What is the most likely diagnosis?

Answer

Answer: Congenital tracheo-oesophageal fistula

Case Discussion:

Arrow points to end of orogastric tube which is blocked from entering the distal esophagus by the the esophageal atresia. Note the gaseous distention of gastrointestinal tract indicating a fistulous tract connects the trachea to the distal esophagus. The blind-end dilated pouch of upper esophagus is seen filling up with the barium.

Congenital tracheo-oesophageal fistula is an abnormal connection between the trachea and oesophagus. TEF is between the upper part of the esophagus and the trachea. The estimated incidence is approximately 1 in 3500 births (1).

Oesophageal atresia/tracheo-oesophageal fistula can be divided into five types (1, 2):
Type A: isolated oesophageal 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%

Plain film
• Radiolucent, blind-end dilated pouch of upper esophagus can be seen on chest x-ray
• Gaseous distention of gastrointestinal tract can be observed (except for type A)
• Images can demonstrate an airless abdomen if the fistula is occluded or obliterated.
• Excessive air can be present in the esophagus in neonates.
• The lungs commonly demonstrate areas of consolidation/atelectasis because of recurrent aspiration.
• Additional imaging procedures are usually not necessary however introduction of a soft catheter into the pouch will prove the diagnosis.

References:
1. Bluestone CD. Pediatric otolaryngology. Saunders. (2003) ISBN:0721691978.
2. Swischuk LE. Imaging of the newborn, infant, and young child. Lippincott Williams & Wilkins. (2004).