Prenatal identification of esophageal atresia: the role of ultrasonography for evaluation of functional anatomy.
OBJECTIVE
To suggest a new ultrasonographic approach for prenatal diagnosis of esophageal atresia (EA).


METHODS
Since 1995, whenever EA is suspected, we perform a systematic multiplanar ultrasonographic scanning of the fetal upper body in order to demonstrate an esophageal pouch. This includes three image plans of the neck and upper chest: coronal, sagittal and axial views in the cephalic direction. The scan time is 20-30 min.


RESULTS
Twenty-five pregnant patients were referred during the period under study for prenatal examinations due to polyhydramnios and/or absent or small stomach. In six fetuses an esophageal pouch was demonstrated at ultrasonography in utero, thus a definitive diagnosis of EA was obtained. All six were confirmed with EA postpartum. In 19 fetuses an esophageal pouch was not demonstrated and all delivered normal neonates. During the same period two additional newborns, who were not included in the referred patients because amniotic fluid volume and stomach size were normal, were diagnosed postpartum with EA. The earliest gestational age of pouch visualization was at 23 weeks. The sagittal view was the best for visualizing a low-level pouch, and the coronal view was optimal for revealing a high pouch.


CONCLUSIONS
Our three-sectional view of the neck and upper chest is useful for in utero detection of esophageal pouch that may enhance the prenatal diagnosis of EA. The positive predictive value for prenatal ultrasound for detecting EA is 100% with a sensitivity of 80%.
Shulman
Adrian
A
Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, Israel. adrian@netvision.net.il
Mazkereth
Rami
R
Zalel
Yaron
Y
Kuint
Jacob
J
Lipitz
Shlomo
S
Avigad
Itamar
I
Achiron
Reuwen
R
D004933:Esophageal Atresia / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D006831:Polyhydramnios / Q000000981:diagnostic imaging; D011247:Pregnancy; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal