{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T22:22:07Z","timestamp":1790029327851,"version":"4.0.1"},"reference-count":8,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2025,4,4]],"date-time":"2025-04-04T00:00:00Z","timestamp":1743724800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>A fetal double bubble sign in early pregnancy should prompt the sonographer to consider the concomitant presence of duodenal atresia and esophageal atresia. Here, we present a case of an early second trimester double bubble sign and enlarged echogenic lungs which entailed a duodenal atresia, esophageal atresia, and congenital high airway obstruction syndrome. Whilst the combination of duodenal atresia with tracheoesophageal fistula has been described previously, the co-occurrence of tracheal atresia is exceptionally unusual. In case of double bubble sign in the first and early second trimester, the possibility of underlying esophageal and tracheal atresia needs to be considered. It is essential to be vigilant about the development of echogenic lungs and, if so, to consider duodenal and esophageal atresia in combination with CHAOS. This constellation of findings is accepted to be lethal. Early sonographic recognition allows for timely counseling and earlier decision-making.<\/jats:p>","DOI":"10.4103\/jmu.jmu_69_24","type":"journal-article","created":{"date-parts":[[2025,4,7]],"date-time":"2025-04-07T04:06:07Z","timestamp":1743998767000},"page":"112-114","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Double Bubble Sign in Early Pregnancy: A Case Report of the Sign of Double Trouble"],"prefix":"10.4103","volume":"34","author":[{"given":"Priyanka","family":"Karine","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Westmead Institute of Maternal Fetal Medicine, Westmead Hospital, Westmead, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Krivanek","sequence":"additional","affiliation":[{"name":"Department of Histopathology, Childrens\u2019 Hospital, Westmead, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roshini","family":"Nayyar","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Westmead Institute of Maternal Fetal Medicine, Westmead Hospital, Westmead, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Christie","sequence":"additional","affiliation":[{"name":"Department of Radiology, Westmead Hospital, Westmead, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Landau","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Westmead Institute of Maternal Fetal Medicine, Westmead Hospital, Westmead, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria-Elisabeth","family":"Smet","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Westmead Institute of Maternal Fetal Medicine, Westmead Hospital, Westmead, NSW, Australia"},{"name":"Sydney Ultrasound for Women, St Leonards, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,4,4]]},"reference":[{"key":"R1-20260327","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1080\/01443615.2017.1342230","article-title":"Clinical outcome of pregnancies with the prenatal double bubble sign \u2013A five-year experience from one single centre in mainland China","volume":"38","author":"Yang","year":"2018","journal-title":"J Obstet Gynaecol"},{"key":"R2-20260327","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1159\/000500471","article-title":"The double bubble sign:Duodenal atresia and associated genetic etiologies","volume":"47","author":"Bishop","year":"2020","journal-title":"Fetal Diagn Ther"},{"key":"R4-20260327","first-page":"225","article-title":"Oesophageal and duodenal atresia suspected at the 12 week booking scan","volume":"108","author":"Dundas","year":"2001","journal-title":"BJOG"},{"key":"R5-20260327","doi-asserted-by":"crossref","first-page":"1146","DOI":"10.1016\/j.jpedsurg.2007.01.044","article-title":"Triad of tracheoesophageal fistula-esophageal atresia, pulmonary hypoplasia, and duodenal atresia","volume":"42","author":"Stark","year":"2007","journal-title":"J Pediatr Surg"},{"key":"R6-20260327","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1002\/jcu.20605","article-title":"Prenatal findings of concomitant duodenal and esophageal atresia without tracheoesophageal fistula (gross type A)","volume":"37","author":"Mitani","year":"2009","journal-title":"J Clin Ultrasound"},{"key":"R7-20260327","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1002\/j.2205-0140.2011.tb00124.x","article-title":"First trimester findings of combined duodenal and oesophageal atresia with a trachea-oesophageal fistula","volume":"14","author":"Sullivan","year":"2011","journal-title":"Australas J Ultrasound Med"},{"key":"R8-20260327","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1016\/j.jpedsurg.2012.03.015","article-title":"Long-term outcomes after fetal therapy for congenital high airway obstructive syndrome","volume":"47","author":"Saadai","year":"2012","journal-title":"J Pediatr Surg"},{"key":"R9-20260327","doi-asserted-by":"crossref","first-page":"E25","DOI":"10.1016\/j.jpedsurg.2003.09.041","article-title":"Acase of laryngeal atresia (congenital high airway obstruction syndrome) with chromosome 5p deletion syndrome rescued by ex utero intrapartum treatment","volume":"39","author":"Kanamori","year":"2004","journal-title":"J Pediatr Surg"}],"container-title":["Journal of Medical Ultrasound"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/jmu.jmu_69_24","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T18:57:42Z","timestamp":1786647462000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/jmu.jmu_69_24"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,4]]},"references-count":8,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/jmu.jmu_69_24","relation":{},"ISSN":["0929-6441","2212-1552"],"issn-type":[{"value":"0929-6441","type":"print"},{"value":"2212-1552","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,4]]},"assertion":[{"value":"2024-06-14","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-07-27","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}