Term female neonate born via emergent C-Term female neonate born via emergent C-section due to non-reassuring fetal heart tracing section due to non-reassuring fetal heart tracing is unstable at birth and required emergent ETT, is unstable at birth and required emergent ETT, NGT, and central line placementNGT, and central line placement

On prenatal US, pt was found to have On prenatal US, pt was found to have hypoplastic left heart, bilateral ventriculomegaly, hypoplastic left heart, bilateral ventriculomegaly, polyhydramnios, absent stomach bubble, and a polyhydramnios, absent stomach bubble, and a single umbilical artery, PDA, and coarctation of single umbilical artery, PDA, and coarctation of the aorta.the aorta.

CXR ordered to assess for tube and line CXR ordered to assess for tube and line placement showed:placement showed:

Case PresentationCase Presentation

Hospital course, outcome, surgery pathHospital course, outcome, surgery path

Pt then underwent barium swallow with tube and suction Pt then underwent barium swallow with tube and suction to confirm EA with TEFto confirm EA with TEF

Diagnosis: Esophageal atresia with distal TE fistulaDiagnosis: Esophageal atresia with distal TE fistula Pt was further evaluated for other VACTERL associated Pt was further evaluated for other VACTERL associated

anomalies (anomalies (VVertebral defect, ertebral defect, AAnorectal malformation, norectal malformation, CCardiac defect, ardiac defect, TTracheoracheoEEsophageal fistula, sophageal fistula, RRenal enal anomaly, anomaly, RRadial dysplasia and adial dysplasia and LLimb defects), imb defects), Head US and subsequent MRI (absent corpus collosum with Head US and subsequent MRI (absent corpus collosum with

hydrocephalus)hydrocephalus) Renal US (normal)Renal US (normal) Water-soluble contrast enema (normal)Water-soluble contrast enema (normal)

Pt underwent thoracotomy to fix TEF and a G-tube was Pt underwent thoracotomy to fix TEF and a G-tube was placed. Pt to the OR on 8/18/06 to repair the hypoplastic placed. Pt to the OR on 8/18/06 to repair the hypoplastic left heartleft heart

Radiographic Radiographic Radiographic Features of EA with distal TEFRadiographic Features of EA with distal TEF

Diagnosed by failure of NG tube to pass and by seeing air distally in stomach on XRDiagnosed by failure of NG tube to pass and by seeing air distally in stomach on XR Typically diagnosed by PA and lateral chest images showing coiled NG tube in Typically diagnosed by PA and lateral chest images showing coiled NG tube in

esophagusesophagus 5 types5 types

Differentiate by air in stomach and symptomsDifferentiate by air in stomach and symptoms May use barium if suspect H-type or EA with double TEFMay use barium if suspect H-type or EA with double TEF Dwayne C. Clark, Esophageal Atresia and Tracheoesophageal Fistula. Am Fam Dwayne C. Clark, Esophageal Atresia and Tracheoesophageal Fistula. Am Fam

Physician 1999 Feb 15;59(4):910-6, 919-20. Physician 1999 Feb 15;59(4):910-6, 919-20.