Evaluation of neonates with esophageal atresia using chest CT scan

Recent literature stresses various factors that influence outcome in neonates with esophageal atresia (EA), including associated congenital anomalies, ventilator dependency, and gap length. Although the existing modalities can fairly accurately assess the first two factors, a comparable modality for assessing the interpouch gap in a natural unstretched position preoperatively is lacking. A technique of direct sagittal computed tomography (CT) scanning of the chest, initially employed by Tam et al. in 1987, was found to provide fairly accurate information on the level of origin of the fistula and the interpouch distance, with pouches in natural, unstretched positions, in two neonates with EA and distal tracheoesophageal fistula (TEF). However, no further studies were reported using this technique. We studied 10 neonates with EA and distal TEF, the most common variant, using this technique. The addition of axial cuts was done in the event of a short upper pouch or suboptimally-clear anatomical details in sagittal chest CT films. The preoperative information in our study subjects was found to corroborate well with operative findings except in the one patient with laryngotracheoesophageal cleft (LTEC). Prior information of a left bronchoesophageal fistula in two of the neonates with dextrocardia greatly helped us in saving operative time and difficulties and postoperative hassles. The chest CT scan proved to be a noninvasive and quick means for investigating neonates with the most common variant of EA. CT scanning could be extended for routine preoperative evaluation of neonates with EA to prepare for intraoperative problems, besides helping prognostication.