H-type tracheoesophageal fistula in an extremely low birth weight premature neonate: appearance on magnetic resonance imaging

Günlemez, Ayla; Anık, Yonca; Elemen, Levent; Tugay, Melih; Gökalp, Ayşe Sevim

doi:10.1038/jp.2008.198

Cited by 16 publications

(7 citation statements)

References 10 publications

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“…However, this is a highly debatable argument considering the significant ionizing radiation related risks in children. Magnetic resonance imaging (MRI) was utilized to diagnose an H-type fistula in a baby weighing 880 grams with suggestive clinical signs despite a negative contrast study (27). The imaging was performed on a 1.5 T magnet using head and neck coil within 5 minutes and without anesthesia.…”

Section: Ureteral Cathetermentioning

confidence: 99%

Management of congenital isolated H-type tracheoesophageal fistula

Durakbaşa¹

2022

Curr Chall Thorac Surg

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Congenital H-type tracheoesophageal fistula (TEF) without associated esophageal atresia (EA) is also called isolated TEF or N-type TEF. The fistula is oblique extending from a cephalad opening on the posterior wall of the trachea to a more caudal position on the anterior esophageal wall. H-type TEF is a rare anomaly comprising about 4% of all EA spectrum of anomalies. Characteristically, the fistula is located at a more cephalad level of the trachea than in TEF associated with EA cases. It is near or above the thoracic outlet in many cases. Coughing, choking and cyanosis during feeding are typical neonatal manifestations of the anomaly and are called the "three-Cs". A high index of suspicion is the key for an early diagnosis. It may be delayed in some cases although they almost always have suggestive pulmonary manifestations. The most commonly employed diagnostic tools are esophageal contrast studies and bronchoscopic evaluation. Contrast studies are preferably performed as a tube esophagogram with pullback technique. Bronchoscopy has a higher diagnostic accuracy and also enables catheterization of the fistula before a surgical intervention. The treatment is surgical. Surgery is usually performed by a lateral cervical approach especially if the level of the fistula is at or above the T2 vertebra level. More caudal fistulas are usually approached either by thoracotomy or thoracoscopy. The most common postoperative complications encountered are recurrent laryngeal nerve injury with resultant vocal cord dysfunction and fistula recurrence. The latter should be repaired by repeat surgery. Vocal cord dysfunction may be temporary and a conservative approach can be undertaken.

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Section: Ureteral Cathetermentioning

confidence: 99%

Management of congenital isolated H-type tracheoesophageal fistula

Durakbaşa¹

2022

Curr Chall Thorac Surg

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“…This occurred was often linked to other co-existent pathologies such as structural cardiac malformations or extreme prematurity. We observed 5 deaths (1.7%) in all eligible reviewed studies [3,12,22].…”

Section: Postoperative Management and Complicationsmentioning

confidence: 86%

“…Endoscopic studies also yielded false-negative results (2.6%), typically within cases of newborns, where the fistula orifice may be small. Non-invasive diagnostic imaging such as high resolution computed tomography (CT) [9] or magnetic resonance imaging (MRI) [12] have also been utilised in preterm newborns and unstable patients (Fig. 2).…”

Section: Diagnosismentioning

confidence: 99%

Diagnostic and management strategies for congenital H-type tracheoesophageal fistula: a systematic review

Sampat

Losty

2021

Pediatr Surg Int

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Background H type tracheoesophageal fistula (H-TEF) is a rare congenital anomaly. Management may be complicated by late diagnosis and variation(s) in the therapeutic strategy. A systematic review of published studies explores the utility of diagnostic studies, operations and postoperative complications. Methods Medline and PubMed database(s) were searched for ALL studies reporting H-TEF during 1997–2020. Using PRISMA methodology, manuscripts were screened for eligibility and reporting. Results Forty-seven eligible studies were analysed. Primary diagnosis varied widely with surgeons performing oesophagography and trachea-bronchoscopy. Preoperative localisation techniques included fluoroscopy, guidewire placement and catheterisation. A cervical approach (209 of 272 cases), as well as thoracotomy, thoracoscopy and endoscopic fistula ligation, were all described. Morbidity included fistula recurrence (1.7%), leak (2%), tracheomalacia (3.4%) and respiratory sequelae (1%). The major adverse complication in all studies was vocal cord palsy secondary to laryngeal nerve injury (18.5%) yet strikingly few centres routinely reported undertaking vocal cord screening pre or postoperatively. Conclusion This study shows that paediatric surgeons record low volume activity with H type tracheoesophageal fistula. Variation(s) in clinical practice are widely evident. Laryngeal nerve injury and its subsequent management warrant special consideration. Care pathways may offset attendant morbidity and define 'best practice.'

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“…Confirm methods NG [16] ( A Gunlemez [21] (1 case) Shu Yi Sonia Lee, [22] (1 case) Peter Donnelly, [23] ( Phalla Ou, MD [24] (1 case) Muhammad Riazulhaq [25] ( Josephiney Y [27] ( via tracheal MB injection also carries the risk of patient choking and asphyxia. In our case, H-type bronchoesophageal fistula was more difficult to detect through bronchoscopy because of the newborn's narrow airway, and after many failures with other tests, our use of a bronchoscopy tracer via esophageal MB injection was successful in detecting the fistula.…”

Section: Times Of Checkmentioning

confidence: 99%

Detection of H-type bronchoesophageal fistula in a newborn

et al. 2022

Medicine

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Rationale: Congenital tracheoesophageal fistula (TEF) is a rare developmental malformation. The H subtype accounts for approximately 4% of TEFs. Unlike other TEFs, the H-type is not accompanied by esophageal atresia and has nonspecific clinical symptoms, and its specific anatomical abnormalities are not always readily apparent. Furthermore, none of the currently available diagnostic methods for H-type TEF have absolute sensitivity, resulting in misdiagnoses, and accurate diagnoses are often delayed even until adulthood; in our case, we detected a congenital bronchoesophageal fistula, which is even more rare than regular H-type TEF, through a technique that was not previously reported for newborns, involving bronchoscopy, with methylene blue injected through an esophagoscope. We believe that we have provided this kind of case first in newborns.Furthermore, because there is not one literature summarizing the clinical symptoms and the effective methods up to now, we still are not clear which detective method is more efficient or accurate, especially in newborns, so it is very necessary to summarize and compare for improving the early diagnosis of TEFs; our study makes a significant contribution to the literature because we collated previously reported cases, including the clinical features and the usefulness and success rates of major tests, which will be very helpful for the early diagnosis of TEFs.Patient concerns: A newborn male presented with an array of nonspecific clinical symptoms from birth, leading to pneumonia and mechanical ventilation. Oral feeding led to an improvement in most but not all symptoms, which returned when oral feeding was resumed. A second round of confirmatory tests was still unable to detect the cause.Diagnosis: The diagnosis of H-type bronchoesophageal fistula was established through a technique that was not previously reported for newborns, involving bronchoscopy, with methylene blue injected through an esophagoscope.Interventions: The surgery was performed after diagnosis, and the bronchoesophageal fistula was successfully repaired.Outcomes: The patient was discharged on postoperative day 7, and his status was reported to be normal at a follow-up visit 8 months after surgery.Lessons: H-type TEF is a rare congenital abnormality, and its early diagnosis is highly difficult, especially bronchoesophageal fistula. Increased oral saliva and air-filled stomachs are characteristic manifestations. Bronchoscopy combined with esophagoscopy can improve the rate of early diagnosis. A combination of tests can improve the detection rate.

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H-type tracheoesophageal fistula in an extremely low birth weight premature neonate: appearance on magnetic resonance imaging

Cited by 16 publications

References 10 publications

Management of congenital isolated H-type tracheoesophageal fistula

Management of congenital isolated H-type tracheoesophageal fistula

Diagnostic and management strategies for congenital H-type tracheoesophageal fistula: a systematic review

Detection of H-type bronchoesophageal fistula in a newborn

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