Food bolus impaction in esophageal atresia | Figure 1

CincyKidsRad

Cincinnati Children's Radiology

Food bolus impaction in esophageal atresia

A frontal radiograph (image 1) post-esophageal atresia repair shows a mediastinal bulge (arrow) displacing the trachea (arrowhead) to the left. An esophagram reveals a food bolus within the dilated proximal esophageal pouch (arrow). There is a small amount of aspiration outlining the tracheobronchial tree (arrowhead). Esophageal strictures are common following esophageal atresia repair. The stricture can lead to food bolus impaction.

Similar cases

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.

An esophagram performed during endoscopy shows a focal stricture (arrow) of the mid-esophagus with marked dilation of the proximal esophagus.

What are potential causes for an esophageal stricture, and how is it treated?

Lateral (image 1) and AP (image 2) images from an upper GI examination in a neonate with bilious vomiting show a 'double bubble' sign with a dilated proximal duodenum (arrow) and gastroesophageal reflux (arrowhead). Small amounts of contrast pass beyond the dilated duodenum (dashed arrow). The differential diagnosis for a 'double bubble' includes duodenal atresia, duodenal web, and annular pancreas. Duodenal atresia is excluded when contrast is seen passing the dilated duodenum. An annular pancreas, which is pancreatic tissue encircling the second portion of the duodenum, is difficult to distinguish from a duodenal web in a neonate due to overlapping clinical and imaging features.

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.