Double Bubble Sign in Early Pregnancy: A Case Report of the Sign of Double Trouble

A fetal double bubble sign in early pregnancy should prompt the sonographer to consider the concomitant presence of duodenal atresia and esophageal atresia. Here, we present a case of an early second trimester double bubble sign and enlarged echogenic lungs which entailed a duodenal atresia, esophageal atresia, and congenital high airway obstruction syndrome. Whilst the combination of duodenal atresia with tracheoesophageal fistula has been described previously, the co-occurrence of tracheal atresia is exceptionally unusual. In case of double bubble sign in the first and early second trimester, the possibility of underlying esophageal and tracheal atresia needs to be considered. It is essential to be vigilant about the development of echogenic lungs and, if so, to consider duodenal and esophageal atresia in combination with CHAOS. This constellation of findings is accepted to be lethal. Early sonographic recognition allows for timely counseling and earlier decision-making.