Investigations
1st investigations to order
antenatal ultrasound
Test
A part of routine antenatal screening or in cases of suspected chromosomal anomaly or familial syndrome. If evidence of polyhydramnios, fetal MRI is also recommended.
Result
polyhydramnios and a small or no stomach bubble
antenatal MRI
Test
While polyhydramnios has high sensitivity for oesophageal atresia/ tracheo-oesphageal fistula, it has been shown to have low specificity and positive predictive value.[22] Fetal MRI can assist in confirming the diagnosis and determining other congenital anomalies.
Result
oesophageal pouch and small stomach
x-ray chest and abdomen
Test
Evidence of respiratory distress or poor handling of secretions, or an inability to pass a nasogastric tube warrants an x-ray. An x-ray of the chest and abdomen with a nasogastrc tube in place should also be obtained immediately after birth in patients who are suspected to have an oesphageal atresia/tracheo-oesophageal fistula on antenatal ultrasound
Result
nasogastric tube coiled in upper pouch
Investigations to consider
bronchoscopy
Test
Suspicion of an H-type fistula due to recurrent aspiration, although rare, warrants bronchoscopy.
Also helpful to identify tracheo-oesophageal fistula, as well as secondary fistulas. The practice of routine bronchoscopy for this purpose is widely debated and varies by area.[21]
Result
presence of a fistula
oesophagoscopy
Test
Performed with suspicion of H-type tracheo-oesophageal fistula.
Result
presence of a fistula
barium swallow
Test
Performed if H-type fistula is suspected. Patients present with evidence of recurrent aspiration. It is often difficult to visualise the fistula.
Result
contrast in trachea
trasnthoracic echocardiogram
Test
Assessment of structural cardiac and great vessel anomalies allows for preoperative risk assessment as well as surgical approach.
Result
Rule out presence of right-sided aortic arch
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