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February 1989

Radiological Cases of the Month

Author Affiliations

From the Department of Radiology, Royal Alexandra Hospital for Children, Sydney, Australia.

Am J Dis Child. 1989;143(2):251-252. doi:10.1001/archpedi.1989.02150140145038

A male infant was born to a 21-year-old mother (gravida 1, para 1) following pregnancy complicated by transient oligohydramnios at 34 weeks. Shortly after birth, an imperforate anus and passage of meconium through the urethra were noted. A defunctioning transverse colostomy was performed with closure of a rectourethral fistula.

Persistent right-upper- and midlung pneumonia developed on day 3 of life (Fig 1) and continued without resolution despite three weeks of intensive antibiotic therapy.

Denouement and Discussion  Right-Upper-Lobe Esophageal Bronchus (With VATER Anomalies)A barium esophagogram (Fig 2) indicates an anomalous origin from the midthoracic esophagus of a bronchus to the consolidated portion of the right lung. The branching pattern of the bronchi is irregular, and the bronchi are dilated. Free gastroesophageal reflux was present. A bronchogram (Fig 3) shows a smooth tapering constriction of the distal trachea and an elongated, narrowed right bronchus supplying the aerated right lower lobe. An

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