Shortly after birth, an infant develops abdominal distention and begins to drool. When she is given her first feeding, it runs out the side of her mouth, and she coughs and chokes. Physical examination reveals tachypnea, intercostal retractions, and bilateral pulmonary rales. The esophageal anomaly that most commonly causes these signs and symptoms is illustrated by which of the following?

Abdominal distention, choking, drooling, and coughing associated with feedings are symptoms of esophageal anomalies. The anomaly illustrated by D is the most common; that of A can be diagnosed after repeated episodes of pneumonia. The anomalies in E and C are associated with all the same symptoms except abdominal distention, which cannot develop because air cannot enter the gastrointestinal tract. B and C are the least common; in these, the upper esophageal segment is connected directly to the trachea, and massive entry of fluid into the lungs occurs.VATER association, a complex of cardiovascular malformations, skeletal malformations, and renal abnormalities, has tracheoesophageal fistula as a common finding.