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Findings: A babygram demonstrates a feeding tube at the level of the thoracic inlet. In addition, there is complete lack of gas in the abdomen. Esophogram and a G-tube study injection of esophageal pouch from above reveals proximal tracheal esophageal fistula at level of thoracic inlet with aspiration of a small amount of barium.

Diagnosis: Proximal tracheal esophageal fistula.

Discussion: The entity is secondary to incomplete division of the primitive foregut. Various types of abnormal division, most common of which is proximal esophageal atresia with a distal tracheal esophageal (TE) fistula occurring in 82-86% of individuals. Others include esophageal atresia without fistula occurring in 8-9% of so affected individuals, esophageal atresia with a proximal TE fistula occurring in 1%, proximal and distal TE fistula 1-2%, and a TE fistula without atresia, so-called H-type, occurring in 6% of individuals.

Radiographically, there is inability to pass a feeding tube into the stomach (esophageal atresia). May also see gasless abdomen in those patients with esophageal atresia and proximal TE fistula, such as in the current case. There is non-hyperparastalsis in the esophageal segment in the mid esophagus in this individual. Aspiration pneumonia can occur in such affected individuals (especially in the dependant upper lobes).

Associated anomalies seen in from 17-70% of individuals, encompass cardiac, musculoskeletal (vertebral, radial ray anomalies), gastrointestinal, genitourinary, and chromosomal (trisomy18, 21, and 13).

Complications after repair include anastomotic leak, recurrent TE fistulal aspiration pneumonia secondary to esophageal stricture disordered esophageal motility or gastro- esophageal reflux.

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