This x-ray shows anomalies associated with VACTERL (vertebral anomalies, anal atresia, cardiac malformations, tracheoesophageal fistula, esophageal atresia, renal anomalies and radial aplasia, and limb anomalies) syndrome. Note the vertebral segmentation anomaly (white arrowhead), enteric tube coiled in the atretic proximal esophagus (black arrowhead), gas in the bowel consistent with esophageal atresia with tracheoesophageal fistula, and deformity of the left upper extremity.