Definitive diagnosis and surgical planning of H-type tracheoesophageal fistula in a critically ill neonate: First experience using air distension of the esophagus during high-resolution computed tomography acquisition

Abstract

Congenital tracheoesophageal fistula without esophageal atresia, commonly referred to as H-type fistula, corresponds to a fistula between the posterior wall of the trachea and the anterior wall of the esophagus.' The diagnosis is suspected on the clinical triad including choking and cyanosis on feeding, gaseous distension of the gastrointestinal tract, and recurrent lower respiratory tract infections. In routine practice, the symptoms are nonspecific, and the diagnosis of H-type fistula is difficult and often delayed. The various diagnostic modalities are not entirely reliable, and fistula identification is generally elusive. 2 The present case highlights the potential diagnostic utility of high-resolution computed tomography (CT) scanning in this clinical situation.