pediatrics
Esophageal Atresia
Diagnosis of Esophageal Atresia
Prenatal: Ultrasonography Postnatal: Nasogastric tube (NGT) or orogastric tube placement and x-ray Routine prenatal ultrasonography may suggest esophageal atresia. Polyhydramnios may be present but is not specific to the diagnosis because it can occur with many other disorders. The fetal stomach bubble may be absent but only in fewer than half of cases. Less commonly, there is a dilated upper esophageal pouch, but this is typically looked for only in fetuses with polyhydramnios and no stomach bubble. After delivery, an NGT or an orogastric tube is inserted if esophageal atresia is suspected by prenatal ultrasonography or clinical findings; diagnosis of esophageal atresia is suggested by inability to pass the tube into the stomach. A radiopaque catheter determines the location of the atresia on x-ray. In atypical cases, a small amount of water-soluble contrast material may be needed to define the anatomy under fluoroscopy. The contrast material should be quickly aspirated back because it can cause a chemical pneumonitis if it enters the lungs. This procedure should be done only by an experienced radiologist at the center where neonatal surgery will be done. 