AP abdominal radiograph in a newborn with vomiting shows a d | Figure 1

CincyKidsRad

Cincinnati Children's Radiology

AP abdominal radiograph in a newborn with vomiting shows a dilated, gas-filled stomach (white arrow) and proximal duodenum (black arrow) with an absence of distal bowel gas (the classic “double bubble” sign). The size and shape of the proximal duodenum and lack of distal gas strongly suggest a chronic in utero obstruction, most likely duodenal atresia (which was confirmed surgically). #TummyTuesday

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A double bubble can be caused by chronic obstruction of the proximal duodenum. The most common entity to cause a double bubble sign is duodenal atresia. Other entities in the differential diagnosis include an annular pancreas, duodenal web, and malrotation. #FridayQuiz

AP radiograph of the abdomen shows a distended air-filled stomach (arrowhead) and proximal duodenum (arrow). The distended structures gives a "double bubble" appearance. A double bubble can be seen in the setting of duodenal atresia, annular pancreas, and duodenal web. Approximately 30% of patients with duodenal atresia have trisomy 21.

Duodenal Atresia: Probe patency is absent. Baby had recurrent vomiting & double bubble sign on X-ray abdomen. The proximal dilated portion is the stomach.Proximal part is given a transverse incision and distal one a vertical incision, they are anastomosed in the shape of a diamond.\Surgical Treatment performed: Duodenoduodenostomy.

Radiograph of the chest and abdomen (image 1) and focused radiograph of the upper chest (image 2) shows dilation of the proximal esophageal pouch (arrow) with an enteric tube stopping within the pouch. There is no distal bowel gas. Esophageal atresia is often associated with tracheoesophageal fistula. In most instances, the tracheoesophageal fistula connects to the distal esophagus. In these instances, air is present within loops of bowel. Patients without distal bowel gas either have isolated esophageal atresia or tracheoesophageal fistula connected to the proximal esophagus.