Duodenal Atresia Etiology: congenitalAXR: large air fluid levels in stomach and duodenal bulb with no distal bowel gas (double bubble sign)Clinical: can be associated with esophageal atresia Cases of Duodenal Atresia Supine (left) and upright (right) AXR shows large air fluid levels in the duodenal bulb (to the right of the spine) and in the stomach (to the left of the spine). There is no distal bowel gas. CXR | AXR shows a nasogastric tube in the proximal esophagus and a massively distended abdomen. Transverse US image of the upper abdomen (below) shows a dilated duodenal bulb (left) and a dilated stomach (right), a double-bubble sign. AXR AP shows a double bubble sign with a dilated stomach to the left of the spine and duodenum to the right of the spine with a small amount of distal bowel gas. Surgical image shows a massive fluid filled stomach (on the left) and duodenal bulb (on the right) which was found to contain over 400 cc of fluid.