Antenatal real‐time diagnosis of esophageal atresias

Abstract

In cases in which it is suspected that polyhydramnios is due to anomalies of the digestive tract, the absence of fluid in the fetal gastrointestinal tract suggests the diagnosis of esophageal atresia. This diagnosis can be made by observing the alternating filling and emptying of the esophagus proximal to the site of atresia. CASE 1A 28-year-old woman gravida 111, para 11, was referred to our hospital because of a uterus too big for dates, which by palpation was 37-weeks size. The ultrasound scan showed polyhydramnios and a biparietal diameter (BPD) of 86 mm, equivalent to 33 weeks, which corresponded to her last menstrual period. Absence of fluid in the stomach and intestine ( Fig. 1) was noted in the fetus. As the study was performed with real-time and recorded on video tape, an alternating filling and emptying of a large proximal esophagus was seen (Figs. 2 and 3), suggesting esophageal atresia Type I as the most probable diagnosis (Type I Ladd's classification: esophageal atresia without tracheoesophageal fistula). 'I2 The umbilical cord contained two vessels and the alpha feto protein in amniotic fluid was just above the upper limit of normal. No other fetal abnormality was found.Spontaneous vaginal delivery took place 5 days after the ultrasound study was performed, resulting in the birth of a female baby weighing 2120 g. After birth the esophageal atresia was clinically confirmed and a thoracoabdominal radiograph showed a distended gastric chamber with air and a gasless intestine (Fig. 4). This finding changed the diagnosis made before delivery from Type I esophageal atresia to esophageal atresia with

Sonography of the fetal gastrointestinal tract: anatomic variants, diagnostic pitfalls, and abnormalities.

“…The most commonly identified esophageal anomaly is esophageal atnesia, a diagnosis that is based on sonographic demonstration of polyhydnamnios in association with an inability to visualize a fluid-filled stomach [1]. Unfortunately, esophageal atresia cannot be diagnosed on excluded simply by evaluating the status of the fetus's stomach.…”

Five Year Experience in Prenatal Ultrasound Diagnosis of Esophageal Atresia in Saudi Arabia

“…3,6,7 In our series, the incidence of EA was 0.13%, which reflects a high incidence of this anomaly in Saudi Arabia. 1,4,8 The total number of congenital anomalies diagnosed in this period were 1345, or 2.3% of all births in our hospital, which represents 5.7% of all congenital anomalies detected.…”

“…Ultrasound diagnosis of EA was made at about 24 weeks of gestational age and was followed up by serial ultrasound antenatally. 6 The ultrasound can identify structural problems either by direct visualization of the defect or its effect (dilated proximal esophagus or absent stomach bubbles). 17 The presence of polyhydramnios should direct the attention of the sonologist to a distended upper pouch and disturbance of esophageal motility, features that are suggestive of esophageal atresia.…”

Oesophageal atresia

“…There have been several reports of the ®nding of a blind ending pouch in the fetal neck, although this sign has not been identi®ed prior to 26 weeks' gestation (Eyheremendy and P®ster, 1983;Vijayaraghavan, 1998;Kalache et al, 1998). This ultrasound ®nding appears to have a high speci®city for oesophageal atresia since all reported cases with a blind ending pouch in the neck have subsequently been con®rmed to have oesophageal atresia.…”