Band neutrophil sign: a strong first-trimester ultrasound marker of combined duodenal and esophageal atresia.

OBJECTIVES To reveal a first-trimester sonographic marker associated with combined duodenal and esophageal atresia (DA and EA). METHODS This retrospective study included four patients referred to our department in the first trimester due to fetal stomach anomaly. In the literature we found 20 additional cases of combined DA and EA with four of them to be revealed at 12 weeks. RESULTS We present the largest for to date case series of combined DA and pure EA diagnosed in the first trimester including one with additional visualization of the distal esophageal pouch and its communication with the stomach. All our cases and four previously published reports (including two cases of DA and EA with tracheoesophageal fistula (TEF)) were characterized by the presence of "band neutrophil sign" - a symmetrical C-shaped loop in the fetal abdomen, occupying a central position close to the anterior abdominal wall. Similar findings could be seen also later in pregnancy, but they lack the same prognostic value. CONCLUSIONS Band neutrophil sign is a pathognomonic first-trimester ultrasound marker of combined DA and EA irrespective of the presence of TEF. Nevertheless, it should be further evaluated in prospective studies. This article is protected by copyright. All rights reserved.