Subtle Presentation of Type B Esophageal Atresia.

Esophageal atresia (EA) is a rare congenital anomaly of the foregut. Several anatomic variants have been described, ranging from isolated esophageal discontinuity to forms associated with tracheoesophageal fistula, with some variants occurring far less frequently than others. A premature infant (33 weeks, 1.5 kg) presented with a gasless abdomen and a nasogastric tube coiled at T4. Bronchoscopy revealed a Grade 1 laryngeal cleft without fistula, consistent with type A EA, and a gastrostomy was placed. The initial six-vertebral gap shortened to 2.5 over six weeks. Collis gastroplasty and thoracic anastomosis were performed. Postoperative esophagram revealed a tract to the airway, suggesting a type B EA. Repeat bronchoscopy confirmed the fistula, which was closed via a cervical approach. Recovery and follow-up imaging were uneventful. Type B EA is rare and easily missed. Repeat imaging and bronchoscopy are crucial for accurate diagnosis and management.