Case report: Upper neck pouch sign in the antenatal diagnosis of esophageal atresia

Abstract

Prenatal diagnosis of esophageal atresia remains a challenge for the imaging consultant. On antenatal USG, the finding of an absent or small stomach in the setting of polyhydramnios used to be considered suspicious of esophageal atresia. However, these findings have a low positive predictive value. The upper neck pouch sign is another sign that helps in the antenatal diagnosis of esophageal atresia. In this paper, I report a case of esophageal atresia that was diagnosed on USG at 27 weeks of gestation; the diagnosis was confirmed postnatally.

Keywords

Esophageal atresia - upper neck pouch sign

• References

• 1 Farrant P. The antenatal diagnosis of esophageal atresia by ultrasound. Br J Radiol 1980;53:1202-3.
• 2 Stringer MD, Kathleen M, Ruth BG. Prenatal diagnosis of esophageal atresia. J Pediatr Surg 1995;30:1258-63.
• 3 Houben CH, Curry JI. Current status of prenatal diagnosis, operative management and outcome of esophageal atresia/tracheo-esophageal fistula. Prenat Diagn Feb 27 2008.
• 4 Kalache KD, Chaoui R, Mau H. The upper neck pouch sign: A prenatal sonographic marker for esophageal atresia. Ultrasound Obstet Gynecol 1998;11:138-40.
• 5 Kalache KD, Wauer R, Mau H. Prognostic significance of the pouch sign in fetuses with prenatally diagnosed esophageal atresia. Am J Obstet Gynecol 2000;182:978-81.
• 6 Rossi C, Domini M, Aquino A. A simple and safe method to visualize the inferior pouch in esophageal atresia without fistula. Pediatr Surg Int 1998;13:535-6.
• 7 Fraser c, Baird PA, Sadovnick AD. A comparison of incidence trends for esophageal atresia and tracheoesophageal fistula, and infectious disease. Teratology 1987;36:363-9.
• 8 Pretorius DH, Drose JA, Dennis MA. Tracheoesophageal fistula in utero. J Ultrasound Med 1987;6:509-13.
• 9 Germal JC, Mahour GH, Woolley MM. Esophageal atresia and associated anomalies. J Pediatr Surg 1976;1:299-306.
• 10 Holder TM, Cloud DT, Lewis JE Jr. Esophageal atresia and tracheosophageal fistula: A survey of its members by the surgical section of the American Academy of Pediatrics. Pediatrics 1964;34:542-9.
• 11 Pretorius DH, Gosink BB, Clautice-Engle T. sonographic evaluation of the fetal stomach: Significance of nonvisulization. AJR Am J Roenteol 1988;151:987-9.
• 12 Kim J, Kim P, Hui CC. The VACTERL association: Lessons from the Sonic hedgehog pathway. Clin Genet 2001;59:306-15.
• 13 Bovicelli L, Rizzo N, Orsini LF. Prenatal diagnosis and management of fetal gastrointestinal abnormalities. Semin Perinatol 1983;7:109-11.
• 14 Satoh. Antenatal sonographic detection of the proximal esophageal segment: specific evidence for congenital esophageal atresia. J Clin Ultrasond ;23:419-23.
• 15 Branthberg. Esophageal obstruction-prenatal detection rate and outcome. Ultrasound Obstet Gynecol 2007;30:180-7.