Multidetector-row computed tomography three-dimensional volume reformatted ‘transparency’ images to define an upper pouch fistula in oesophageal atresia

Abstract

Oesophageal atresia (OA) is an important congenital malformation in which prompt diagnosis and appropriate management can significantly improve outcome. The surgical approach to repair of OA and associated tracheo-oesophageal fistulae (TOF) depends upon correct evaluation of the tracheobronchial tree. Three-dimensional imaging of the tracheobronchial tree using CT data to produce shaded surface displays and virtual bronchoscopy has been reported in paediatric and neonatal patients with OA and TOF and is described as accurate and helpful, non-invasively facilitating the appreciation of complex anatomy prior to surgery. We describe the technique of reconstructing 3D volume-reformatted 'transparency' images using insufflated air as a negative contrast medium. This technique is fast, accurate and produces high-quality images that are easy to reproduce.

Management of a congenital tracheoesophageal fistula in a young Spanish water dog

“…However, the air-filled pouch between the main bronchi would raise a suspicion of abnormal anatomy, even if the bronchoscopy does not reveal the orifice of the TEF. In neonate children, the concurrent use of air during CT has been a valuable aid in the diagnosis of TEF, serving as a negative contrast medium [21,22]. …”

KTP laser: An important tool in refractory recurrent tracheo-esophageal fistula in children

“…If a child has respiratory symptoms following repair of a TOF then a diagnostic modality for recurrent or missed fistula is essential. DLTB, oesophagoscopy three-dimensional CT scanning [5] have all been documented as useful. The incidence of recurrent fistulae is 5-14% [6] and it is usually the first differential diagnosis when a patient has respiratory symptoms following repair of a TOF.…”

The value of preoperative CT scan in newborns with type C esophageal atresia

“…With this noninvasive investigation, they were able to establish a correct diagnosis in these neonates with esophageal atresia. Although a few investigators had emphasized the advantages of preoperative CT scan in patients with EA-TEF, which defined the anatomy of the fistula and the interpouch distance [5][6][7][8], this procedure is not routinely part of the diagnostic and surgical approach in many neonatal surgical centers. We report our experience with routine preoperative CT scans with type C EA in the last 5 years.…”