What clinical sign on an X-ray is most associated with malrotation with volvulus in neonates?

The double bubble sign is a classic radiographic finding that is most commonly associated with malrotation with volvulus in neonates. This sign is indicative of a blockage in the duodenum, where air is trapped in the stomach and the proximal portion of the duodenum due to obstruction, creating two distinct air-filled structures on the X-ray.

When a neonate experiences malrotation, it means that the intestines have not followed the normal developmental rotation, which can lead to volvulus or twisting of the intestines. This twisting can obstruct the passage of air and fluids through the bowel, leading to the characteristic double bubble appearance. The air in the stomach and proximal duodenum forms the two bubbles, while the distal bowel remains devoid of air, which is not visualized on the X-ray.

In contrast, other signs such as free air under the diaphragm may indicate perforation of the gastrointestinal tract, which is not specifically associated with malrotation and volvulus. Similarly, massive bowel dilation could be seen in various intestinal obstructions but is not specific to malrotation. Lastly, a single bubble sign is generally not representative of the typical findings in cases of malrotation, as it would suggest an obstruction elsewhere rather than the specific pathology seen in volv