Review Article Unveiling tracheo-oesophageal fistula: The crucial role of imaging in the diagnosis and management

Poonam Sherwani, Nivedita Sharma, Rajat Piplani, Ekakshi Varshney, Sumit Kumar

South African Journal of Radiology | Vol 29, No 1 | a3216 | DOI: https://doi.org/10.4102/sajr.v29i1.3216 | © 2025 Poonam Sherwani, Nivedita Sharma, Rajat Piplani, Ekakshi Varshney, Sumit Kumar | This work is licensed under CC Attribution 4.0
Submitted: 26 May 2025 | Published: 23 September 2025

About the author(s) Poonam Sherwani, Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences (AIIMS), Rishikesh, India
Nivedita Sharma, Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences (AIIMS), Rishikesh, India
Rajat Piplani, Department of Pediatric Surgery, All India Institute of Medical Sciences (AIIMS), Rishikesh, India
Ekakshi Varshney, Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences (AIIMS), Rishikesh, India
Sumit Kumar, Department of Radiology and Imaging, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GPIMER), Delhi, India

Abstract

Tracheo-oesophageal fistula (TOF) is a significant congenital anomaly characterised by an abnormal communication between the trachea and the oesophagus. Prompt diagnosis and surgical intervention are crucial, but long-term outcomes depend on accurate imaging and postoperative monitoring. The article discusses the embryological basis, clinical presentation and various types of TOF with their imaging techniques. Immediate and long-term postoperative complications are also discussed. Recent advances such as Ultrashort Echo Time (UTE), MRI and the Oesophageal Anastomotic Stricture Index (OASI) have expanded the capabilities of imaging in predicting surgical outcomes and guiding follow-up.
Contribution: This review highlights the pivotal role of imaging in the diagnosis, classification, surgical planning and follow-up of TOF, focusing on current and emerging modalities.

Keywords

contrast oesophagogram; oesophageal stricture; tracheo-oesophageal fistula; ultrashort echo time MRI; VACTERL association; fistulous; foregut

Sustainable Development Goal

Goal 3: Good health and well-being

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