Clínica de Diagnóstico por Imagem – CDPI, Rio de Janeiro - Brazil.

Definition

Esophageal atresia is a congenital failure of the full esophageal lumen to develop. It occurs in 1 in 10,000 births, and 90% of the fetuses with esophageal atresia have a tracheoesophageal fistula. Careful observation of the fetal abdomen can be helpful. Dilatation of the esophageal pouch can be seen in the upper chest. Two thirds of them have polyhydramnios and one-third have absent fluid-filled stomach. Over half of affected fetuses have chromosomal abnormalities (mostly trisomy 21) or other morphological abnormalities (especially cardiac). The karyotype should be considered.

Case report

We report the prenatal diagnosis of esophageal atresia in a 32-year-old healthy primiparous woman, who was admitted for ultrasound evaluation at 17 week’s gestation because nonvisualized stomach. The ultrasound showed also polyhydramnios. The same view was observed by fetal MRI at 26 weeks. A female infant (46, XX) weighing 3.300 g was delivered by Cesarean section at 38 weeks with Apgar scores of 8 at 1 minute and 9 at 5 minutes. The neonate was discharged home on day 8 after surgery. The esophageal atresia was confirmed.

Figures 1, 2: Ultrasound (axial view) shows polyhydramnios and nonvisualization of the stomach.

Figures 3, 4: MRI (sagittal T2). Note fluid filled blind ending esophageal pouch.

Figures 5, 6: MRI (axial T2) of the thorax and abdomen.

Figure 7: MRI (coronal T2).

References

Pretorius DH et al.: Tracheoesophageal fistula in utero. Twenty-two cases. J Ultrasound Med 6: 509-13, 1987.