Tracheoesophageal fistula without esophageal atresia: are pull-back tube esophagograms needed for diagnosis?
BACKGROUND
A pull-back tube esophagogram (PBTE) is widely accepted in the literature as the radiological investigation of choice for the diagnosis of tracheoesophageal fistula without esophageal atresia. However, PBTE is rarely performed in our institution, as we have been successful in confirming the presence of such fistulae with a contrast material swallow (CS). We hypothesized that PBTE is not the radiological investigation of choice for the diagnosis of the fistula in this condition.


OBJECTIVE
We sought to determine what proportion of patients with tracheoesophageal fistula without esophageal atresia can be diagnosed promptly by a CS and what the indications are for a PBTE.


METHODS
We retrospectively analyzed the clinical and radiological findings in patients with tracheoesophageal fistula without esophageal atresia to determine whether the fistula was diagnosed with a CS or PBTE.


RESULTS
We identified 20 children (13 female and 7 male) with tracheoesophageal fistula without esophageal atresia. Their age at diagnosis ranged from 3 days to 168 months with a median of 9 days. The diagnosis was documented by CS in 12, PBTE in 7 and CT in 1. In three of the seven who had the fistula documented by PBTE, a previous CS had shown contrast material in the trachea, but no fistulous tract or aspiration was identified.


CONCLUSIONS
We believe that CS should be the examination of choice in most patients suspected of having a tracheoesophageal fistula without esophageal atresia. A PBTE is indicated in patients who are intubated or are at significant risk of aspiration. Furthermore, a PBTE is also indicated where contrast material is seen in the airway on CS and there is uncertainty whether this is due to aspiration or a fistula.
Laffan
Eoghan E
EE
Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, M5G 1X8, Canada.
Daneman
Alan
A
Ein
Sigmund H
SH
Kerrigan
Debbie
D
Manson
David E
DE
D000284:Administration, Oral; D000293:Adolescent; D002675:Child, Preschool; D003287:Contrast Media / Q000008:administration & dosage*; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D014138:Tracheoesophageal Fistula / Q000151:congenital / Q000000981:diagnostic imaging*
D003287:Contrast Media