2 month old with type C tracheoesophageal fistula with long | Figure 1

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Case Overview

2 month old with type C tracheoesophageal fistula with long gap esophageal atresia. Gap measured at 4 cm by simultaneous insertion of flexible bronchoscopes in proximal and distal esophageal pouches (via nose and gastronomy stoma) with mild pressure as x ray taken.

Images

Image from an upper GI examination in a neonate with a history of recurrent pneumonia shows the right lower lobe bronchus arising from the esophagus. An esophageal bronchus is an incredibly rare congenital bronchopulmonary foregut malformation. Esophageal bronchi are more common on the right side and occur more frequently in girls. They are associated with other anomalies including duodenal atresia, distal tracheoesophageal fistula, esophageal atresia, and congenital heart disease.

9 month old with type C tracheoesophageal fistula / esophageal atresia. Recurrent TEF following esophageal dilation months prior at other institution; large enough to drive a 3.1mm flexible bronchoscope through. Awaiting repair developed resp failure due to human metapneumovirus. Hard to ventilate due to leak through TEF. Stabilized with Fogarty balloon in esophagus occluding fistula and held in place by esophageal stricture. 1st pic before and after. 2nd shows TEF. 3rd/4th shows Fogarty inflated beyond esophageal stricture. 5th shows balloon on CXR.

AP chest radiograph in a newborn shows a nasogastric tube coiled within a dilated gas-filled proximal esophageal pouch, a typical appearance for esophageal atresia. Gas is visualized in the stomach and bowel, confirming the presence of a concomitant tracheo-esophageal fistula.