Clues: coiled nasogastric tube in the upper esophageal pouch with air in the stomach and bowel, plus choking/cyanosis during feeds and abdominal distension.
Associated anomalies occur in about half of affected infants, particularly cardiac defects and VACTERL features, as summarized in this
NCBI review.
Additional confirmation: chest radiograph showing the ETT tip in the trachea, ideally just above the carina and distal to the TEF opening.