PERSISTENT ESOPHAGOTRACHEA

THE MOST SEVERE DEGREE OF LARYNGOTRACHEO-ESOPHAGEAL CLEFT

¹ Assistant in Radiology, Department of Radiology, Children's Hospital Medical Center, Boston, Massachusetts

A case of a newborn with persistent esophagotrachea, a condition in which the respiratory and alimentary tracts are in continuity down to the carina, is reported. Persistent esophagotrachea is the most severe degree of laryngotracheo-esophageal cleft. Infants with persistent esophagotrachea have difficulty with secretions from birth and promptly develop severe aspiration pneumonia (as in cases of esophageal atresia). Usually, a tube can be advanced readily into the stomach however (as in cases of H-type tracheo-esophageal fistula without esophageal atresia). Aphonia is common, possibly universal. Fluoroscopy will show immediate entry of ingested contrast material into the trachea; the shadows of the esophagus and trachea will be difficult or impossible to separate from each other, but no isolated fistula will be demonstrable. Endoscopy should be able to confirm the lack of fusion of the posterior walls of the larynx and trachea. Neither roentgenologic evaluation, nor endoscopy, nor surgical exploration has heretofore been uniformly successful in reaching the correct diagnosis however; this must be at least partly due to lack of knowledge of the condition.

Because diagnosis has been delayed or inaccurate or both and because the problems of surgical repair are formidable, persistent esophagotrachea of the degree exemplified by the case reported here has until now been a rapidly lethal malformation, although 2 cases of milder degrees of laryngotracheo-esophageal cleft have apparently been successfully repaired.

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