OP13.01: The tracheal print: A prenatal sonographic clue to assess the atretic portion in oesophageal atresia

Abstract

Oesophageal atresia (OA) is rarely diagnosed prenatally. Sonographic evaluation of the fetal oesophagus is rarely reported in the literature. When suspected, it is always difficult to confirm it. In most of cases, OA is evoked in the presence of indirect sonographic features, such as polyhydramnios associated with a small or non-visualized fetal stomach. However, the prenatal evaluation of the length of the atretic oesophageal portion is never reported. This is still challenging and need to be detailed for an appropriate counselling, especially in OA of type I. Cases series 3 patients were referred in our centres for polyhydramnios and non-visualized fetal stomach during morphological scan. Targeted ultrasound (US) of both fetal cervical and thoracic structures was performed in each case. The prenatal diagnosis of oesophageal atresia (OA) was made in all cases. The evaluation of the upper part of the oesophagus was made indirectly during fetal swallowing with the presence of the “pouch sign”. The atretic portion was assessed directly thanks to the interruption of the four parallel echogenic lines that correspond to the apposition of the collapsed anterior and posterior oesophageal walls, but also indirectly thanks to the presence of “the tracheal print”. This finding could correspond to an abnormal posterior shift of a limited portion of the posterior wall of the trachea, near the atretic portion of the oesophagus. In all cases, the expected length of the gap was correlated either postnatally and with postmortem analysis. It is now possible to detail directly or indirectly the atretic portion of the oesophagus in case of OA. We have to provide this information to the surgeon for an appropriate counselling.