Congenital broncho-oesophageal fistula associated with tracheal agenesis.

A male infant was born after 37 weeks of an uncomplicated fourth pregnancy to a 21-year-old woman whose previous obstetric history included one abortion and one stillbirth. The infant was delivered by spontaneous breech and did not breathe or cry at birth. He was "intubated" and intermittent positive-pressure respiration was given, but spontaneous respiration was never established. The initial heart rate of 50 beats/min gradually declined and the infant was declared dead 40 minutes after birth. A tracheo-oesophageal fistula was suspected clinically. At necropsy the infant weighed 2120 g and had features of borderline prematurity. The ears were low set and the nose beaked and the eyes were set widely apart. The scrotum was bifid and the anus imperforate. Only a single umbilical artery was found. The trachea could not be identified. The larynx could not be examined as permission for a restricted necropsy only was obtained and the oesophagus was transected below the level of the larynx. When the oesophagus was opened the right and left main bronchi were seen opening on to the anterior wall of the organ, but they were widely patent (fig 1). Below this the oesophagus continued on to the stomach. There was a shallow, linear groove on the luminal aspect of the anterior wall of the oesophagus, above the entry of the bronchi. At the upper end of this groove a nubbin of firm tissue, 1 mm in diameter, was present. The lungs were atelectatic and hypoplastic by weight (combined weight 30 g). Other relevant features noted were an infracristal ven-