Diagnosis: H-type tracheoesophageal fistula

History: 2 day old male born at 35 weeks presents with food intolerance and abdominal distention.

Findings: Filling of the stomach was performed with an orogastric tube. The stomach fundus, body, and antrum are unremarkable without evidence of mass lesion, mucosal abnormality or hiatal herniation. Contrast passes freely through the pylorus distending an unremarkable duodenal bulb and sweep.The ligament of Treitz is in normal position to the left of the lumbar spine and even with the duodenal bulb. The distal esophagus was filled with contrast via the orogastric tube. During filling of the esophagus contrast was noted to enter the trachea through a small tracheoesophageal fistula in the middle third of the esophagus.

Ddx: >> H-type tracheoesophageal fistula >> esophageal tear >> other types of tracheoesophageal fistula >> necrotizing enterocolitis >> malrotation >> duodenal atresia

Dxhow: Water soluble contrast study

Exam: Abdominal distention.