Band neutrophil sign: A strong first-trimester ultrasound marker of combined duodenal and esophageal atresia.

Abstract

To reveal a first-trimester sonographic marker associated with combined duodenal and esophageal atresia (DA and EA). This retrospective study included four patients referred to our department in the first trimester due to fetal stomach anomaly. In the literature, we found 20 additional cases of combined DA and EA with four of them to be revealed at 12 weeks. We present the largest for to date case series of combined DA and pure EA diagnosed in the first trimester including one with additional visualization of the distal esophageal pouch and its communication with the stomach. All our cases and four previously published reports (including two cases of DA and EA with tracheoesophageal fistula [TEF]) were characterized by the presence of "band neutrophil" sign-a symmetrical C-shaped loop in the fetal abdomen, occupying a central position close to the anterior abdominal wall. Similar findings could be seen also later in pregnancy, but they lack the same prognostic value. Band neutrophil sign is a pathognomonic first-trimester ultrasound marker of combined DA and EA irrespective of the presence of TEF. Nevertheless, it should be further evaluated in prospective studies.