Esophageal Atresia X-ray:
Other Cases: Radiological cases of Surgery

It is a congenital condition that can be identified through radiographic findings. Key indicators include:
- Dilated Pharyngeal Pouch: The X-ray may reveal a distended pharyngeal pouch.
- Distal Fistula Indication: The presence of air in the stomach and bowel alongside esophageal atresia suggests a distal fistula.
- Feeding Tube Placement: If a feeding tube has been attempted, the X-ray might show the tube looping back in the upper thorax or entering the trachea/bronchial tree.
What is Esophageal Atresia?
It is a birth defect where a baby’s esophagus (food pipe) doesn’t connect properly to the stomach. Instead, it ends in a pouch, making swallowing impossible. This condition occurs when the Congenital foregut fails to separate into the trachea (windpipe) and esophagus during early fetal development (around 4 weeks gestation).
It’s the most common congenital esophageal anomaly, affecting 1 in 3,000-4,500 newborns. About 50-75% of cases occur alongside other birth defects, making early diagnosis crucial.
Associated Conditions and Risk Factors
Many infants with this condition have additional abnormalities:
Common Associated Conditions
- VACTERL association (Vertebral, Anal, Cardiac, Tracheo-Esophageal, Renal, Limb defects)
- CHARGE syndrome
- Other intestinal atresias (duodenal, jejunoileal, or anal)
- Annular pancreas
- Pyloric stenosis
Genetic Factors
- Trisomy 21 (Down syndrome)
- Trisomy 18 (Edwards syndrome)
- Most cases are sporadic (no clear genetic cause)
Possible Risk Factors
- Maternal antithyroid drug use in early pregnancy
- Environmental teratogens (substances that disrupt fetal development)
Symptoms and Diagnosis of Esophageal atresia
Clinical Signs in Newborns
- Excessive drooling (inability to swallow saliva)
- Choking/coughing during feeding
- Failed nasogastric tube insertion (tube coils back in the esophagus)
- Respiratory distress (due to aspiration)
Prenatal Ultrasound Findings
- Small or absent stomach bubble
- Polyhydramnios (excess amniotic fluid)
- Growth restriction in severe cases
Types of Esophageal Atresia
The condition is classified based on anatomical variations and the presence of a tracheoesophageal fistula (TEF):
Type | Description | Prevalence |
---|---|---|
Type C | Proximal atresia + distal fistula | 85% (most common) |
Type A | Isolated atresia (no fistula) | 8-9% |
Type E (H-type) | Isolated fistula (no atresia) | 4-6% |
Type D | Double fistula with atresia | 1-2% |
Type B | Proximal fistula + distal atresia | 1% |
Diagnostic Imaging of Esophageal atresia
1. X-ray Findings of Esophageal atresia
- Dilated upper esophageal pouch
- Air in stomach (if a distal fistula exists)
- Coiled feeding tube in the chest
2. Fluoroscopy (Contrast Study)
- “Blind-ending” esophagus (contrast pools in the pouch)
- TEF detection (contrast entering the trachea)
3. Ultrasound & CT
- Prenatal ultrasound may suggest the condition
- CT scans help assess complex cases (not routine)
Treatment and Surgery of Esophageal atresia
Surgical Repair (Primary Goal)
- Reconnect the esophagus (primary anastomosis)
- Close any fistulas to prevent aspiration
- Gastrostomy tube may be needed for feeding
Prognosis Factors
- Depends on associated anomalies (heart defects worsen outcomes)
- Gap length between esophageal ends affects surgical success
- Long-term complications may include:
- Strictures (narrowing)
- Gastroesophageal reflux (GERD)
- Swallowing difficulties
Key Takeaways
✅ Most common type (85%) is proximal atresia + distal fistula
✅ Diagnosed via X-ray, fluoroscopy, or prenatal ultrasound
✅ Surgery is required to reconnect the esophagus
✅ VACTERL association is common (check for other defects)
✅ Long-term follow-up is needed for complications
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