![]() ![]() This finding can be confirmed with an anterior-posterior chest radiograph that demonstrates the catheter curled in the upper esophageal pouch ( image 1). In affected infants, the catheter cannot be passed farther than approximately 10 to 15 cm. ĭiagnosis - The diagnosis of EA can be made by attempting to pass a catheter into the stomach. On occasion, the diagnosis may be delayed for longer periods and even into adulthood. These patients typically have a prolonged history of mild respiratory distress associated with feeding or recurrent episodes of pneumonia. In one series, the delay in diagnosis ranged from 26 days to 4 years. However, smaller defects of this type may not be symptomatic in the newborn period. Patients with H-type TEFs may present early if the defect is large, with coughing and choking associated with feeding as the milk is aspirated through the fistula. Reflux of gastric contents through the TEF results in aspiration pneumonia and contributes to morbidity. A fistula between the trachea and distal esophagus leads to gastric distension. Infants with EA become symptomatic immediately after birth, with excessive secretions that cause drooling, choking, respiratory distress, and inability to feed. Additional clinical features relate to the presence of the VACTERL association (a constellation of malformations including vertebral, anal, cardiac, TEF, renal, and limb defects). However, many cases are not detected prenatally. In cases with EA (95 percent), polyhydramnios occurs in approximately two-thirds of pregnancies. Ĭlinical features - The clinical presentation of TEF depends upon the presence or absence of EA. The fistula tract is thought to derive from a branch of the embryonic lung bud that fails to undergo branching because of defective epithelial-mesenchymal interactions. Pathogenesis - TEF and EA are caused by a defect in the lateral septation of the foregut into the esophagus and trachea. (See "Birth defects: Epidemiology, types, and patterns", section on 'Association' and "Renal hypodysplasia", section on 'Genetic disorders'.) There are associated anomalies in approximately one-half of the cases of TEF and EA, often as part of the VACTERL association (vertebral defects, anal atresia, cardiac defects, TEF, renal anomalies, and limb abnormalities) or CHARGE syndrome (coloboma, heart defects, atresia choanae, growth retardation, genital abnormalities, and ear abnormalities) and, especially, with congenital heart or genitourinary defects. Other rare variations have been reported. TEF occurs without EA (H-type fistula) in approximately 4 percent. Type C, which consists of a proximal esophageal pouch and a distal TEF, accounts for 84 percent of cases. EA and TEF are classified according to their anatomic configuration ( figure 1). Ĭlassification - TEF typically occurs with esophageal atresia (EA). TRACHEOESOPHAGEAL FISTULA AND ESOPHAGEAL ATRESIA - Tracheoesophageal fistula (TEF) is a common congenital anomaly of the respiratory tract, with an incidence of approximately 1 in 3500 to 1 in 4500 live births. ![]() (See "Congenital anomalies of the nose" and "Congenital anomalies of the jaw, mouth, oral cavity, and pharynx" and "Congenital anomalies of the larynx".) Disorders of the upper respiratory tract are discussed separately. Anomalies of the intrathoracic airways, including the trachea, bronchi, and lower airways, are reviewed here. INTRODUCTION - Congenital anomalies of the respiratory tract include malformations located anywhere from the nose to the alveoli. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |