The esophageal 'pouch sign': a benign transient finding.
OBJECTIVE
Sonographic finding of an esophageal pouch is considered pathognomonic for fetal esophageal atresia (EA). We investigated the clinical significance of this finding.


METHODS
Longitudinal sonographic follow-up in pregnancy and neonatal diagnostic work-up was performed in six fetuses with an esophageal neck pouch referred for polyhydramnios and a small or absent stomach. Fetal swallowing and cyclic distension of the pouch were observed for at least 30 min, and follow-up examinations were conducted at 2 to 3 weeks intervals.


RESULTS
First visualization of the pouch occurred between 18 and 29 weeks of gestation. All pouches were located above the fetal clavicle. No additional anomalies were detected on detailed anatomic survey. Five fetuses had normal karyotypes. At 21 to 33 weeks of gestation, polyhydramnios had resolved, and the stomach was found to be normal in size and shape in all cases. The neonatal work-up ruled out EA in all cases.


CONCLUSIONS
The fetal esophageal pouch sign occurs in structurally normal fetuses and should not be considered pathognomonic for EA or serve as the grounds for pregnancy termination.
Solt
Ido
I
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA 90048, USA. solti@cshs.org
Rotmensch
Siegfried
S
Bronshtein
Moshe
M
D004933:Esophageal Atresia / Q000000981:diagnostic imaging*; D004947:Esophagus / Q000000981:diagnostic imaging* / Q000196:embryology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D006831:Polyhydramnios / Q000000981:diagnostic imaging; D011247:Pregnancy; D016216:Ultrasonography, Prenatal