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March 1993

Radiological Cases of the Month

Author Affiliations

From the Department of Pediatrics, Division of Neonatology (Drs Patel and Milstein), and Department of Surgery, Division of Pediatric Surgery (Dr Schwartz), University of California, Davis, School of Medicine.

Am J Dis Child. 1993;147(3):307-308. doi:10.1001/archpedi.1993.02160270069021

This 2135-g girl was born at 35 weeks' gestation. The 39-year-old mother was gravida 7, aborta 2, para 5. Four infants were normal but one died at age 2 months with trisomy 9, corrected myelomeningocele, and tetralogy of Fallot. Her current pregnancy was considered normal except for polyhydramnios, shown with ultrasonography at 32 weeks' gestation. The fetus showed two fluid-filled structures in the abdomen believed to represent a distended stomach and duodenal bulb (Fig 1). Chromosomal analysis of the amniotic fluid showed a karyotype of trisomy 21, and a diagnosis of duodenal atresia was suspected.

Apgar scores were 7/9 at 1 and 5 minutes. Physical examination revealed a symmetrically developed, slightly premature infant with facial characteristics of trisomy 21, clinodactyly of the fifth digit, and a loud single second heart sound. The abdomen was soft to palpation and scaphoid in contour.

Because of a history of polyhydramnios and