INFANT WITH DROOLING OF SALIVA

Monday, February 22, 2010
These are the two Xrays (Ap view and Lateral View) of a 02 weeks old infant who was brought to the hospital because of the drooling of Saliva and mother has noticed that during breast feeding the infant begins to cough and struggle as the fluid returns through the nose and mouth.

What are the Abnormalities  you would see in these Xrays?
What are the other important fact that you would like to ask from the mother? 
What are  the tests that you would do to confirm the diagnosis?

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16 comments

  1. Anonymous Says:
  2. according to HX it is esophageal atresia but the x-ray not clean for definitive DX

     
  3. Anonymous Says:
  4. esophageal atresia......ng tube has not passed completly through the esophagus......

     
  5. Anonymous Says:
  6. arash from iran

    1-there is gastric distension infavour of gastric outlet obstruction , it can be due to foreign body , pyloric stenosis or midgut volvulus
    2-Hx of foreign body ingestion , previous Hx of vomiting , color of vomiting , billous or non billous vomiting , projectile vomiting , how long does she or he have vomiting ? post prandial or not postprandial vomiting?olive like mass on epigasteric area , diarrhea constiopation or obstipation
    3-sonography , upper GI series , barium study
    ABG may show metabolic alkalosis

     
  7. Anonymous Says:
  8. aspiration pneumonia maybe due to esophageal atresia, I would like to ask about the presence of tiny, white, frothy bubbles of mucous in the infant's mouth and sometimes in the nose as well. When these bubbles are suctioned away, they reappear.

    Esophageal atresia is indicated if the catheter stops at the blind pouch, indicating that it has hit an obstruction. If EA is present, the catheter will typically stop at 4 to 5 inches (10–12 cm) from the nostrils. Barium-enhanced x-ray examination may reveal a dilated esophageal pouch.

     
  9. Anonymous Says:
  10. arash from iran

    it should be noticed TE fistula can cause gastric distension , in lateral x ray there is suspicious area for TE fistula , for this diagnosis we should ask Hx of reflux , drooling , choking , polyhydraminous in pregnancy , aspiration pneumonia , diagnosis can be confirmed by insertion of NG , imaging study with water soluble contrast

     
  11. Anonymous Says:
  12. esophageal atresia with tracheoesophageal fistula(causing gastric distention)
    x ray (AP)show widening of mediastinum

     
  13. Anonymous Says:
  14. dr.winzo
    pyloric stenosis .ask about projectile vomiting
    unlikely TE fistula??why hyperinfaltion of the lung???????PE:olive like mass is diagnostic with projectile vomiting...can take Bx from pylorus to see the thickening.......

     
  15. Anonymous Says:
  16. proxymal atresia with distal TE fistula

     
  17. Anonymous Says:
  18. esophageal atesia with tracho_esophgeal fistula than cause distention of stomach

     
  19. Anonymous Says:
  20. how did u discover this atresia without barium swallow investigation !!!!!
    t seems that there is a lung hyperinflation, what do u think the cause is?

     
  21. areej Says:
  22. I THINK IT IS ESOPHAGEAL ATRESIA .. the symptoms of child are typical symptoms of atresia ( drooling saliva , cough ), also whe we look to X-ray ..we see distended stomach , and also i think there is a nasogastric tube that's not go down ..

    we have to ask the mother about third trimester polyhydramnios.

     
  23. Admin Says:
  24. Answer for this case is proximal oesophageal fistula with distal tracheo-oesophageal fistula that causes the distension of the stomach with gases.
    Diagnosis is confirmed by doing a barium swallow, prior to that try to pass a NG tube and feel for resistance to pass it down at the level of proximal atresia and xray will show the coiling up of the NG tube.

     
  25. Anonymous Says:
  26. esophageal atresia

     
  27. Anonymous Says:
  28. proximal oesophageal fistula with distal tracheo-oesophageal fistula that causes the distension of the stomach with gases.
    Diagnosis is confirmed by doing a barium swallow, prior to that try to pass a NG tube and feel for resistance to pass it down at the level of proximal atresia and xray will show the coiling up of the NG tube.

     
  29. Bobbymurjani Says:
  30. it s an atresia of oesofagus with tracheoesophagus fistel because there is a gas/air in the stomach and in the small intestine .... its dangerous to perform barium swallow for this condition because of aspiration of the contrast media.. so maybe i suggest to use the air contrast can be made ...

     
  31. ARASH Says:
  32. HPS

     

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