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Nonrandom association of anomalies involving multiple organ systems
V ertebral/vascular
A nal atresia/auricular
C ardiac
T racheoesophageal fistula
E sophageal atresia
R enal/radial ray/rib
L imb
VACTERL association diagnosed when ≥ 3 of above malformations present; causative gene unknown
Actively seek other features of VACTERL association when 1-2 components present
Initial imaging in suspected cases: Radiographs & US
Radiographs: Spine & limbs (if limb anomaly present on physical exam)
US: Head, spine, renal/bladder, echocardiography
Further imaging depends on clinical exam & initial imaging findings
Incidence of VACTERL: 1/10,000 to 40,000 liveborns
Children with VACTERL: 72% have 3 anomalies, 24% have 4 anomalies, 8% have 5 anomalies
Cardiac: 40-80%
Renal: 50-80%
Anal: 55-90%
Tracheoesophageal: 50-80%
Vertebral: 60-80%
Limb: 40-50%
Consider VACTERL in child with vertebral & other anomalies
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