Tracheoesophageal fistulas (TEF)

Tracheoesophageal fistulas (TEF)

The most common type of TEF is esophageal atresia with distal esophageal communication with the tracheobronchial tree. This accounts for >80% of cases.

  • • The next most common type is esophageal atresia without a Tracheoesophageal fistulas, which accounts for 3% to 9% of cases.
  • • H-type fistulas occur between an otherwise intact trachea and esophagus and account for 3% of cases.
  • • Esophageal atresias occurring with proximal and distal communication with the trachea are found in 1% of cases, and esophageal atresia with proximal communication is rare (<1%).

Tracheoesophageal fistulas is associated with VACTERL syndromes (in which affected patients manifest at least three of the following: V ertebral anomalies, A nal atresia/imperforate anus, C ardiac anomalies, T racheo e sophageal fistula/esophageal atresia, R enal anomalies, and L imb anomalies).

What are the X ray findings of Tracheoesophageal fistulas?

In a patient with esophageal atresia (and no fistula or a proximal fistula), radiographs may reveal a gasless abdomen. A nasogastric tube may be seen coiled within the proximal esophagus. Patients with esophageal atresia with a distal TEF or H-type fistula may present with a distended abdomen. Pulmonary aspiration is a risk for all patients with esophageal atresia.

How can a radiograph help to differentiate an ingested coin in the esophagus from an aspirated coin in the trachea?

On frontal chest radiographs, a coin in the esophagus is typically visualized as a round object en face (i.e., a full radiopaque circle can be seen). A coin in the trachea lies sagittally and will typically appear end-on (in profile) on the frontal radiograph.


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