Radiology, Vol 151, 637-641, Copyright © 1984 by Radiological Society of North America
Recurrent tracheo-esophageal fistula: a protocol for investigation
DA Stringer and SH Ein
Following repair of esophageal atresia and tracheo-esophageal (TE) fistula,
the fistula may recur in approximately 10% of patients and is often
difficult to diagnose. The authors review the clinical and radiographic
findings in 16 cases. Clinical findings are nonspecific; however, recurrent
TE fistula may be suspected when the plain radiograph reveals an air
esophagram (44% of cases), gas in the abdominal portion of the bowel (50%
of those who had abdominal radiographs), or a "beaked" appearance of the
anterior wall of the esophagus (50% of negative barium examinations). Oral
barium studies resulted in 17 false negatives and 4 true positives, while a
right lateral decubitus esophagram with a vertical beam gave 2 false
negatives and 2 true positives, and a prone esophagram with a horizontal
beam gave 2 true positives and no false negatives. Despite the small number
of cases, the authors suggest that a prone view with a horizontal beam,
rather than a decubitus examination, is the procedure of choice for
recurrent TE fistulas.
