Case report: Complex tracheoesophageal malformation with lethal outcome in a premature infant

Laryngo-Rhino-Otologie, vol. 103, pp. S349

Abstract

Introduction Congenital tracheoesophageal malformations are rare and often associated with other comorbidities. While esophageal atresias have a survival rate of about 90%, tracheal atresias are often incompatible with life. Patient and method We report on a premature girl (1085g) who became cyanotic and required resuscitation immediately after birth. As the intubation failed and a laryngeal cleft was clinically suspected, our ENT department was called in for co-evaluation. Some oxygenation was possible via esophageal intubation, which is why a tracheoesophageal fistula also seemed likely. Next to this, an echocardiogram showed a hypoplastic left heart syndrome with aortic arch hypoplasia. In the case of unclear tracheal anatomy, a CT scan was performed when circulation was stabilized, followed by surgical neck exploration. In the meantime, the child required resuscitation again and died of respiratory global insufficiency. Result In the postmortem interdisciplinary CT consultation, the diagnosis of a complex tracheoesophageal malformation with tracheal atresia, laryngeal cleft and esophageal atresia type IIIc a (Vogt classification) was made. With the additional cardiovascular comorbidities, this disease pattern is not compatible with life. Discussion The suspicion of a tracheoesophageal malformation is usually only suspected after birth. Indications of tracheal atresia are severe respiratory distress, no audible cry and failure of intubation. Since such a setting requires rapid interdisciplinary action, a profound knowledge of such malformations is essential not only for pediatricians but also for ENT specialists. Publication History Article published online: 13 May 2024 © 2024. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Authors 3

1. Thien An Duong Dinh Aachen Klinik für Hals-, Nasen-

   Universitätsklinikum Aachen

   Affiliation as printed

   Universitätsklinikum Aachen, Klinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Hals-Chirurgie, Aachen

2. Konrad Heimann Aachen Klinik für Kinder- und Jugendmedizin

   Universitätsklinikum Aachen

   Affiliation as printed

   Universitätsklinikum Aachen, Klinik für Kinder- und Jugendmedizin, Aachen

3. Sebastian Philipp Schraven Aachen Klinik für Hals-, Nasen-

   Universitätsklinikum Aachen

   Affiliation as printed

   Universitätsklinikum Aachen, Klinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Hals-Chirurgie, Aachen