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Congenital tracheoesophageal fistula without atresia: an incidental finding
L Oğuzkurt1, F Balkanci, M Ariyürek
1Department of Radiology, Hacettepe University Faculty of Medicine, Ankara.
Insights
A congenital H-type fistula, a rare condition, was incidentally diagnosed in a child with growth retardation and abdominal pain. This case highlights the importance of considering rare diagnoses even without classic symptoms.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging
- Congenital Abnormalities
Background:
- Congenital H-type tracheoesophageal fistula (TEF) is a rare anomaly.
- Classical symptoms include choking, cyanosis, and recurrent pneumonia, often presenting in infancy.
- Diagnosis can be challenging, especially in atypical presentations.
Observation:
- A four-year-old boy presented with recurrent abdominal pain and a history of upper respiratory infections and growth retardation.
- During an upper gastrointestinal series, contrast medium was observed in the trachea.
- Esophagography confirmed a congenital H-type fistula.
Findings:
- The patient lacked typical infantile symptoms of TEF such as feeding difficulties or recurrent lower respiratory infections.
- Growth retardation was the only consistent sign suggestive of a fistula.
- The diagnosis was incidental, discovered during investigation for abdominal pain.
Implications:
- This case underscores the variability in clinical presentation of congenital H-type fistulas.
- Diagnostic imaging, like esophagography, is crucial for identifying rare anomalies.
- Awareness of atypical presentations can aid in earlier diagnosis and management of congenital TEF.
Abstract:
A four-year-old boy who had a long history of upper respiratory tract infections and growth retardation was admitted because of recurrent abdominal pain. During upper gastrointestinal series to search for a gastric or duodenal ulcer, the examiner noticed a minute amount of contrast medium within the trachea. Repeat esophagography on an angiographic table led to the correct diagnosis of a congenital H-type fistula. The patient did not have the classical symptoms of a history of choking and cyanosis after feeding during infancy or recurrent lower respiratory tract infections. The only finding consistent with a fistula was growth retardation, and the diagnosis was established incidentally during a work-up for abdominal pain.