MyPACS.net: Radiology Teaching Files > Case 8796093

previously visited 070417 ESOPHAGEAL ATRESIA WITH TE FISTULA AND DUODENAL STENOSIS
Contributed by: pedrad CSH, Radiologist, Chung Shan Medical University Hospital, Taiwan.
Patient: 1 day old male
History: Newborn baby.
Much saliva and yellowish secretion since birth.

Birth history:
No specific finding, except oligohydramnion during normal spontaneous delivery.
Images:[small]larger

Fig. 1: Skull

Fig. 2: Chest

Fig. 3: KUB

Fig. 4: UGI

Fig. 5: LGI

Fig. 6: CT-1

Fig. 7: CT-2

Fig. 8: CT-3

Fig. 9: CT-4

Fig. 10: CT-5

Fig. 11: CT-6

Fig. 12: CT-axi

Fig. 13: CT-cor

Fig. 14: CT-sag

Fig. 15: CT-axi

Fig. 16: 3D

Fig. 17: animator

Fig. 18: Post-OP UGI-1

Fig. 19
Findings:

Skull (Figure 1):
1. Post nasogastric tube with looped catheter in upper third
   esophagus, may due to esophageal atresia.

Chest and KUB (Figure 2,3):
1. Post nasogastric tube with looped catheter in upper third
   esophagus and air retention in GI tract, suggesting
   esophageal atresia with tracheoesophageal fistula.
2. Much air retention in stomach and proximal duodenum but
   minimal distal bowel gas, in favor of duodenal stenosis
   with unknown etiology.
3. Increased infiltration in both lungs, predominant over
   right upper lobe, may due to inflammatory process.
4. Recommendation: Further evaluation with color Doppler
   ultrasound or MRI to exclude midgut volvulus and other
   detectable possibility. Thank you!

Esophageogram (Figure 4):
1. Contrast media stop in upper third esophageal pouch,
   in favor of esophageal atresia

Barium enema (Figure 5):
1. No detectable anomaly. No evidence of intestinal
   malrotation from this study.

CT with oral and IV contrast (Figure 6-17):
1. History of esophageal atresia with tracheoesophageal fistula,
   S/P surgery with nasogastric tube.
2. Relative dilatation of stomach and proximal duodenum with
   some contrast media in distal bowel, in favor of duodenal
   stenosis.
3. Well demonstration of superior mesenteric artery and vein
   without twisting, midgut volvulus is not likely.
4. No grossly abnormal finding in pancreas, annular pancreas is
   not favored although poor image resolution due to too small
   size of patient.
5. Focal windsock dilatation of 2nd/3rd portion of duodenum with
   air containing, duodenal web may be compatible.

Post operation Upper GI Series (Figure 18,19):
1. History of esophageal atresia, tracheoesophageal fistula,
   and duodenal stenosis, S/P surgery.
2. Mild contrast stasis in upper esophagus, due to post operation
   esophageal strnosis.
3. Patency of deudenum.

Diagnosis: Esophageal atresia with TE fistula and duodenal stenosis
Discussion: Common differential diagnosis of neonatal duodenal obstruction:
1. Malrotation with midgut volvulus
    (an emergency, must be exclude immediately)
2. Duodenal atresia
    (an example of complete intrinsic obstruction)
3. Duodenal stenosis
    (an example of an incomplete intrinsic abnormality, ex: duodenal web)
4. Preduodenal portal vein
    (an example of duodenal extrinsic stenosis)
5. Annular pancreas
Comments:
No comments posted.
Additional Details:

Case Number: 8796093Last Updated: 04-30-2007
Anatomy: Gastrointestinal (GI)   Pathology: Congenital
Modality: CT, Conventional Radiograph, GI, 3D ReconstructionAccess Level: Readable by all users
Keywords: esophageal atresia, fistula, duodenal, stenosis, webACR: 739.1432

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