The Spectrum of Esophageal Atresias

Esophageal atresia is a congenital anomaly related to incomplete formation of the esophagus with or without the presence of a tracheoesophageal (TE) fistula. While the exact cause is unknown, it is felt to be related to incomplete separation of the primitive foregut into the trachea and the esophagus. One accepted classification of esophageal atresia and TE fistulas is as follows:

A. Atresia without TE fistula
B. Atresia with proximal TE fistula
C. Atresia with distal TE fistula (most common)
D. Atresia with proximal and distal TE fistula
E. TE fistula without atresia

Esophageal atresia is usually suspected in the setting of polyhydramnios, excessive salivation, choking/cyanosis during feeding, and inability to pass a nasogastric/feeding tube to the stomach. Anteroposterior and lateral radiographs will reveal a blind-ending, air-filled proximal esophagus. Radiographs of the abdomen should also be performed to evaluate for air in the GI tract, the presence of which raises suspicion for a distal TE fistula. Fluoroscopy may be used to confirm findings in which case water soluble contrast is preferred.

The above images are from a newborn with a history of difficulty feeding. The initial radiograph reveals a dilated upper esophagus without air seen in the GI tract. A nasogastric tube was placed which coiled in the proximal esophageal stump. Via a percutaneous gastrostomy tube, contrast was introduced into the stomach which refluxed into a distal esophageal remnant without evidence for fistulous connection. Type A esophageal atresia was diagnosed.


REFERENCES

Berrocal T, Torres I, Gutierrez J, et al. Congenital anomalies of the upper gastrointestinal tract. Radiographics. 1999;19:855-72.