Diagnostic Considerations
Consider adult presentation of congenital tracheoesophageal fistula (TEF) (ie, recurrent TEF) in adults who present with cough and recurrent aspiration pneumonia. [11] Recurrent TEF in adults may be a late complication of surgical repair performed when they were children.
Pharyngeal pseudodiverticulum should be considered in the differential diagnosis of TEFs. This may occur secondary to traumatic perforation of the posterior pharynx from finger insertion into the oropharynx during labor or following vigorous efforts at tube insertion during resuscitation of the newborn. These patients develop pneumomediastinum.
A very rare cause of neonatal respiratory distress is tracheal agenesis, which is always fatal within hours of birth. In tracheal agenesis, a nasogastric tube can be inserted easily.
Zenker diverticulum is also known as posterior hypopharyngeal pouch and pharyngoesophageal diverticulum. This condition involves herniation of mucosa and submucosa through the oblique and transverse fibers of the cricopharyngeus muscle. The blind pouch develops at the pharyngoesophageal junction at the level of the C5-C6 disc space. The pouch is the result of hyperdynamic cricopharyngeal sphincter contraction associated with an abnormality of cricopharyngeal relaxation.
Differential Diagnoses
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Zenker Diverticulum
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Tracheoesophageal fistula. During development of respiratory and digestive systems, a single primitive tube develops lung bud and tracheoesophageal septum forms by 4-6 weeks of gestational age. The septum separates the foregut and tracheobronchial tree by 6 weeks of gestational age.
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Tracheoesophageal fistula (TEF). The cuff of endobronchial causes circumferential ischemia and injury to the trachea; the erosion leads to formation of a TEF.
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Tracheoesophageal fistula. H-type of tracheoesophageal fistula.
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Tracheoesophageal fistula. Esophageal atresia with distal tracheoesophageal fistula.
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Tracheoesophageal fistula. Isolated esophageal atresia without tracheoesophageal fistula.
Tables
Anatomic Characteristics |
Percentage of Cases |
Esophageal atresia with distal TEF |
87 |
Isolated esophageal atresia without TEF* |
8 |
Isolated TEF |
4 |
Esophageal atresia with proximal TEF |
1 |
Esophageal atresia with proximal and distal TEF |
1 |
*Classified as TEF although there is no fistula. |
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