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Difficulties in diagnosis of congenital H-type tracheo-oesophageal fistulae
1Department of Radiology, St George's Hospital, London.
Insights
Diagnosing congenital H-type tracheo-oesophageal fistulae in neonates can be challenging. Early use of tube esophagograms is recommended for suspected H-type fistulae to improve diagnostic accuracy.
Area of Science:
- Pediatric Surgery
- Neonatal Medicine
- Diagnostic Imaging
Background:
- Congenital H-type tracheo-oesophageal fistula is a rare anomaly.
- Diagnosis in the neonatal period is crucial for timely intervention.
- Recurrent chest infections are a common presenting symptom.
Purpose of the Study:
- To review diagnostic methods for H-type tracheo-oesophageal fistulae.
- To identify factors contributing to diagnostic delays.
- To recommend optimal diagnostic strategies.
Main Methods:
- Retrospective review of 12 pediatric cases diagnosed between 1980-1986.
- Analysis of clinical presentation, chest radiographs, and contrast studies.
- Evaluation of diagnostic yield of different imaging techniques.
Main Results:
- Eight out of 12 patients had abnormal chest radiographs.
- Ten out of 19 contrast studies were negative.
- Tube esophagograms demonstrated fistulae more effectively than conventional studies.
Conclusions:
- Delayed diagnosis, not delayed presentation, impacts surgical timing.
- Early tube esophagography is recommended for suspected H-type fistulae.
- Consider bronchoscopy if initial imaging is inconclusive.
Abstract:
The case notes of 12 children with congenital H-type tracheo-oesophageal fistulae diagnosed at the Hospital for Sick Children, Great Ormond Street, who presented between 1980 and 1986 were reviewed. All patients presented early in the neonatal period with recurrent chest infections; abnormal chest radiographs were found in eight. Ten of a total of 19 contrast studies were negative. Tube oesophagograms were more likely to demonstrate a fistula than conventional contrast studies. Any delay in surgery was due to delay in diagnosis rather than to delay in presentation. The results suggest that tube oesophagograms should be performed early where there is clinical suspicion of an H-type fistula, and that other investigations (for example bronchoscopy) should be considered if the tube oesophagogram does not demonstrate a fistula.