The first clinical sign of an infant with EA is maternal polyhydramnios resulting from the infant’s inability to swallow and absorb amniotic fluid through the gut. Polyhydramnios is seen in infants with many diagnoses; only 1 in 12 infants with polyhydramnios have EA. Polyhydramnios is seen in 95% of infants with EA and no fistula and in 35% of patients who have EA with a distal fistula. Increased pressure due to the amniotic fluid accumulation results in a greater number of premature births and neonates with low birth. One third of infants with EA weigh less than 2250 g.
Most infants with EA become symptomatic within the first few hours of life, unlike children with an isolated fistula, who have more subtle symptoms that may not be recognized initially. Excess salivation and fine, frothy bubbles in the mouth and sometimes nose result from an inability to swallow. Any attempts at feeding result in choking, coughing, cyanotic episodes, and food regurgitation. The presence of a fistula increases respiratory complications due to aspiration of food and secretions in the trachea and lungs. Pneumonitis and atelectasis develop quickly in the affected neonate, and rattles heard during respirations are common. Fistulas also allow air to enter the stomach and intestines, leading to abdominal distension. With atresia alone, the abdomen appears scaphoid.
Many anomalies are associated with EA, and 50-70% of children with EA have some other defect.
Once the EA is considered, appropriate diagnostic procedures are necessary. The simplest and quickest diagnostic procedure is the passage of a 10 to 12 French oral tube into the esophagus. If an obstruction encountered (usually in 9 to 13 cm), EA is likely. If the tube passes belong this point, atresia is unlikely. In either case, a radiograph of the chest must be obtained to confirm the position of the tube.
Although ultrasonography has no role in the routine postnatal evaluation of EA and/or TEF, prenatal sonography is a valuable screening tool for EA and/or TEF. The diagnostic accuracy is increased if an anechoic area is present in the middle of the fetal neck; this sign differentiates EA from diseases with possible swallowing impairments.
Provide much information, including findings for EA confirmation and depiction of the side of the aortic arch side, the presence of any vertebral or other associated anomalies, and others. Barium studies performed after the surgical placement of a gastrostomy may be used to evaluate the gap length and associated GI abnormalities such as duodenal atresia or malrotation. However, radiographs may not always demonstrate the presence of a fistula.
Findings on posteroanterior and lateral chest images confirm a diagnosis of EA by displaying a coiled nasogastric tube (placed for determination of EA) in the proximal esophageal pouch of a child with EA. Any vertebral anomalies may be visualized, and some cardiac anomalies may be suggested. Aspiration pneumonia, especially in the right upper lobe, and patchy atelectasis are frequently present. Aside from these general findings, the radiographic observations in children with EA and/or TEF vary depending on the type of anomaly present.