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A 25-year-old multigravida was referred to Radiology Department for routine second trimester obstetric ultrasound examination. It was spontaneous conception from a nonconsanguineous marriage. Ultrasound examination showed a single live foetus with parameters corresponding to 24 weeks of gestation. Bilateral lungs were enlarged and echogenic with inversion of diaphragm. Dilated trachea and bronchi were noted with heart displaced in midline. There was presence of mild polyhydramnios. There was presence of double bubble sign in the abdomen indicating duodenal atresia. No other foetal anomalies were seen. The diagnosis of congenital high airway obstruction syndrome (CHAOS) was made on antenatal ultrasound (Figure 1). She had an intrauterine foetal demise at 25 weeks. Labour was induced and she delivered a dead female foetus weighing 800 g. Foetal autopsy revealed presence of CHAOS and duodenal atresia.

Antenatal ultrasonography depicting congenital high airway obstruction syndrome with duodenal atresia