Infant Pneumonitis Due to a Tracheoesophageal Fistula: A Presentation of Two Autopsy Cases

Area of Science:

• Pediatric pathology
• Congenital abnormalities
• Gastrointestinal development

Background:

• Esophageal atresia (EA) and tracheoesophageal fistula (TEF) are rare congenital abnormalities of the upper gastrointestinal tract.
• EA with or without TEF is the most common congenital defect of the upper GI tract.
• The Gross classification categorizes EA/TEF into five types (A-E/H), with Type E/H posing diagnostic challenges due to continuous esophageal structure.

Observation:

• This paper details two infant autopsy cases involving TEF and aspiration pneumonitis.
• Aspiration pneumonitis is a chemical injury from inhaled gastric contents, distinct from infectious aspiration pneumonia.
• Histopathological examination revealed interstitial pneumonitis as the main finding in both cases.

Findings:

• The histopathology showed lymphocytes, plasma cells, and macrophages on alveolar walls, indicative of chemical pneumonitis.
• The absence of eosinophils ruled out hypersensitivity as a cause.
• Interstitial pneumonitis was identified as the direct cause of death in both cases.

Implications:

• Highlights the critical link between TEF, aspiration pneumonitis, and mortality in infants.
• Emphasizes the importance of histopathological analysis in diagnosing the cause of interstitial pneumonitis in neonates.
• Underscores the challenges in diagnosing Type E/H TEF due to delayed symptom onset.