PRECISE localization of an H-type tracheoesophageal fistula in infants is often difficult even with cine-esophagography.9 When simpler means are insufficient, endoscopic catheterization using the forward-viewing cystoscope has been successful. The telescopic lens system at the tip of the catheter can be used to explore suspicious areas on the posterior tracheal wall, and an ureteral catheter can be passed through even a tiny fistula into the distal esophagus.
Bronchial collapse during expiration in emphysematous patients, commonly observed bronchoscopically, has now been demonstrated to be due solely to the high intrapulmonary pressure built up during expiration.15 The high pressures develop because of the need to expel the previously inhaled air by muscle contractions. In normal individuals with unimpaired intrinsic elasticity of the pulmonary tissue, the intrathoracic pressure during expiration remains slightly below or just at the atmospheric level. In emphysema the intrathoracic pressure becomes positive, sometimes markedly so. Another
PUTNEY FJ. Bronchoesophagology. Arch Otolaryngol. 1965;82(1):83–85. doi:10.1001/archotol.1965.00760010085021
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