The flaccid trachea and tracheoesophageal congenital anomalies

The patient with an esophageal atresia associated with a distal tracheoesophageal fistula, is often found to have an abnormally soft trachea. The use of contrast material as an aid in the diagnosis of this congenital anomaly demonstrates radiologically the compressive effect that a dilated and hypertrophied proximal esophageal pouch has on the trachea of the newborn. It is postulated that this chronic compressive force plays a part in retarding the development of the trachea during fetal life. The important decompressive effect of a distal tracheoesophageal fistula allowing nonphysiologic escape of lung fluid, supplements this effect. Attention is drawn to the fact that tracheal compression plays an important part in the respiratory distress seen in these patients, both before and after surgical correction of the tracheoesophageal anomaly.