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Esophageal atresia (gastric pull-up procedure)

Case contributed by Melbourne Uni Radiology Masters
Diagnosis certain

Presentation

Pleuritic chest pain.

Patient Data

Age: 22 years
Gender: Female

Chest X-ray

x-ray

There is extensive air space opacification due to infection involving all segments of the right lung. The appearances of the right hemithorax maybe due to prior surgery for esophageal atresia and pull-up of the stomach into the right hemithorax.

The left hemithorax is clear.

No pulmonary embolism. The mediastinum appears normal. No pericardial effusion. No aortic dissection involving the arch or descending aorta is evident. There is no mediastinal, hilar or axillary lymphadenopathy.

A large collection within the right hemithorax represents stomach (the patient had a gastric pull through procedure as a neonate) and not massive empyema. The stomach does appear rather distended. There are some gastric vessels demonstrated coming up from the celiac axis. The distended stomach may be related to a recent large meal. However, a gastric outlet obstruction may need to be considered. Clinical correlation suggested, and further investigation indicated as required. There does appear to be a small amount of right-sided pleural fluid adjacent to the stomach. The right lung appears anteriorly compressed. There is consolidation affecting the right lung anteriorly likely related to atelectasis. Pneumonia cannot be completely excluded. There is a shift of the mediastinum to the left.

No endobronchial lesion is seen.

Case Discussion

This patient was diagnosed with esophageal atresia as a baby. She had successful corrective surgery at that time.

Esophageal atresia refers to an absence of the continuity of the esophagus due to an inappropriate division of the primitive foregut into the trachea and esophagus. it is a condition usually diagnosed in the neonatal period. Some relevant facts about esophageal atresia include: 

  • it is the most common congenital anomaly of the esophagus (~1:3000-4500 live births)
  • may be sporadic, but most are found associated with other abnormalities: 
    • other intestinal atresias: duodenal atresia, jejunoileal atresia, anal atresia
    • annular pancreas
    • pyloric stenosis
    • VACTERL
    • CHARGE syndrome
    • chromosomal anomalies such as: trisomy 21 and trisomy 18
  • it is frequently associated with a tracheo-esophageal fistula , with the majority of them (~85%) characterized by a proximal atresia with distal fistula

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