Esophageal Atresia With H-Type Tracheo-Esophageal Fistula

Etiology: Congenital
Imaging UpperGI:
— To diagnose requires forceful contrast injection through feeding tube using pullback technique with patient in left lateral and left anterior oblique positions starting in the distal esophagus
— False negative UpperGIs are common
DDX:
Complications: Aspiration pneumonia
Treatment: Surgical
Clinical:
— Third most common (4%) esophageal atresia
— Should be considered in patient who coughs or chokes with feeding
— May present with recurrent aspiration pneumonias
— Diagnosis often delayed
— Less associated with other anomalies

Radiology Cases of Esophageal Atresia With H-Type Tracheo-Esophageal Fistula

2 lateral images from an upper GI shows contrast in the esophagus as expected (posteriorly) and in the airway unexpectedly (anteriorly). An H-type fistula is clearly seen connecting the airway and the esophagus.

UGI of esophageal atresia with H-type tracheo-esophageal fistula — CXR (left) shows dextrocardia and diffuse lung infiltrates bilaterally. Oblique image from a pull-back esophagram performed with a nasogastric tube while injecting low-osmolar water soluble contrast in the distal esophagus (right) shows opacification of the trachea and bronchial tree via a fistula.

CXR shows diffuse infiltrates in the right upper and lower lobes and hyperexpansion. An upper GI showed a fistula between the esophagus and trachea.