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J Thorac Cardiovasc Surg 2007;133:1116-1117
© 2007 The American Association for Thoracic Surgery

Brief Communication

Definitive diagnosis and surgical planning of H-type tracheoesophageal fistula in a critically ill neonate: First experience using air distension of the esophagus during high-resolution computed tomography acquisition

Phalla Ou, MDa,*, Elisa Seror, MDa, Wael Layouss, MDa, Yann Révillon, MD, PhDb, Francis Brunelle, MD, PhDa

a Department of Pediatric Radiology, University Rene Descartes-Paris V, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
b Department of Pediatric Surgery, University Rene Descartes-Paris V, Hôpital Necker-Enfants Malades, AP-HP, Paris, France.

Received for publication November 30, 2006; accepted for publication January 5, 2007.

* Address for reprints: Doctor Phalla Ou, Department of Pediatric Radiology, Hôpital Necker-Enfants Malades, 149, rue de Sèvres 75743 Paris Cedex 15, France. (Email: phalla.ou@nck.ap-hop-paris.fr).

The first 20% of the full text of this article appears below.

Congenital tracheoesophageal fistula without esophageal atresia, commonly referred to as H-type fistula, corresponds to a fistula between the posterior wall of the trachea and the anterior wall of the esophagus.1Go The diagnosis is suspected on the clinical triad including choking and cyanosis on feeding, gaseous distension of the gastrointestinal tract, and recurrent lower respiratory tract infections. In routine practice, the symptoms are nonspecific, and the diagnosis of H-type fistula is difficult and often delayed. The various diagnostic modalities are not entirely reliable, and fistula identification is generally elusive.2Go

The present case highlights the potential diagnostic utility of high-resolution computed tomography (CT) scanning in this clinical situation.

Clinical Summary

A 3-week-old boy was transferred to our hospital for malposition of the great arteries with multiple ventricular septal defects that had been diagnosed on antenatal ultrasonographic exam. Surgical intervention consisted of pulmonary banding.

Five days after surgery, he had severe respiratory distress . . . [Full Text of this Article]






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Copyright © 2007 by The American Association for Thoracic Surgery.