[size=20px]An infant with esophageal atresia with distal tracheoesophageal fistula (EATEF) is transferred to your service. Your preoperative evaluation demonstrates a cardiac ventriculoseptal defect, a hemivertebra and normal appearing kidneys on bedside screening ultrasound. Head and spine ultrasounds are normal.

 

After repair of EATEF and recovery, additional early testing should include

 

A head computerized tomography (CT) scan.

 

B spinal magnetic resonance imaging (MRI).

 

C voiding cystourethrogram.

 

D cardiac catheterization.

 

E extremity radiographs.[/size]

(Untitled)

 

b

think again my dear

(Untitled)

 

e

think again my dear

C

E

C

correct

 

In infants with esophageal atresia and tracheoesophageal fistula with the VACTERL association, genitourinary anomalies are found in 20 to 24% of patients. The VACTERL association is the statistically nonrandom co-occurrence of a group of congenital malformations including vertebral, anorectal, cardiac, trachea, esophageal, renal and limb anomalies. Conventionally, the identification of at least three anomalies is required to assign the VACTERL association label. Recognizing VACTERL association allows for a targeted work up for specific anomalies including vertebral dysplasia, spinal cord anomalies, esophageal atresia, tracheoesophageal fistula, congenital heart disease, renal anomalies and radial limb deformities. Genitourinary anomalies occur in about 25% of all infants with VACTERL association thus making a complete work up with renal ultrasound and voiding cystourethrogram warranted in all patients.

 

There is no specific role for routine head computerized tomography scan unless hydrocephalus is identified on head ultrasound (US). Likewise, a spinal US is a good screening test for spinal anomalies including tethering of the spinal cord. Magnetic resonance imaging might be utilized in those infants for follow up in patients where US suggests anomaly. Echocardiography is sufficient for assessing associated congenital cardiac anomalies such that cardiac catheterization is not routinely warranted. Limb anomalies such as radial agenesis are usually obvious on physical exam and plain radiographs are not needed.

(Untitled)

 

i disagree with this..

Voiding cystourethrogram is not routine work up in TOF or VACTERL.

If the renal US is normal then no need for further imaging.

Regards

I would like to see the support for this answer ©

I would like to see the support for this answer ©

You can read explanation two posts above your post