How is it Diagnosed?
Tracheoesophageal fistula (TEF) is a congenital or acquired abnormal connection
between the trachea and esophagus, most commonly detected in newborns. In
neonates, diagnosis is suspected shortly after birth when symptoms such as excessive
drooling, choking during feeds, coughing, cyanosis, or abdominal distension are noted.
Initial evaluation involves clinical suspicion followed by attempts to pass a nasogastric
(NG) or orogastric tube, which typically fails to progress into the stomach if TEF with
esophageal atresia is present. Chest and abdominal X-rays taken with the NG tube in
place often reveal the coiled tube in the upper esophageal pouch and may show air in
the stomach indicating a fistula.
Contrast esophagography with a water-soluble agent can delineate the anatomy of the
esophagus and fistulous tract, though caution is exercised to avoid aspiration.
Bronchoscopy and esophagoscopy may be used for direct visualization and
confirmation in complex cases or to diagnose acquired TEFs, especially in adults.
Prenatal diagnosis is possible with ultrasound showing polyhydramnios and a small or
absent fetal stomach bubble. Fetal MRI can provide additional anatomical detail.
In acquired TEFs (e.g., from malignancy, trauma, or prolonged intubation), CT scans,
barium swallow studies, and endoscopy are diagnostic tools. TEF requires prompt
surgical intervention in neonates to prevent aspiration and nutritional compromise.