History: A 50-year-old man with a history of mild dysphagia.
A single-contrast esophagram was performed.
A CT scan of the upper abdomen withoral and intravenous contrast was obtained in portal venous phase.
Esophagram: The single-contrast esophagram demonstrates smooth, broad-based, extrinsic mass effect on the lower third of the esophagus, displacing the esophagus slightly laterally. There is normal single-contrast appearance of the esophageal walls without evidence of esophageal diverticulum.
CT: There is a hypodense mass with thin walls and no calcifcations located near the gastroesophageal junction, abutting the aorta, in the inferior and posterior mediastinum, displacing the esophagus laterally.
- Esophageal duplication cyst
- Lymphatic malformation
- Neurenteric cyst
- Bronchogenic cyst
Diagnosis: Esophageal duplication cyst
Esophageal duplication cyst
Esophageal duplication cyst is part of a class of lesions termed as foregut duplication cysts.
Foregut duplication cysts may be located adjacently to the esophagus, duodenum, jejunum, or ileum.
They are thought to be due to the persistence of an abnormal embryonic foregut vacuole.
Up to 50% of cases may contain ectopic gastric mucosa.
These lesions are congenital and nonfatal; therefore, they are present in all age groups. Symptomatic cysts, however, generally present in childhood.
Esophageal duplication cysts are usually discovered incidentally.
Symptomatic esophageal duplication cysts present with symptoms of mass effect on the esophagus.
Esophagram: May demonstrate extrinsic mass effect on the esophagus.
Ultrasound: Appears as a hypoechoic structure adjacent to the esophagus with posterior acoustic enhancement, consistent with a simple cyst.
CT: Appears as a hypodense lesion adjacent to the esophagus with thin walls and lack of aggressive features, such as thick sepatations, mural nodularity, or gross invasion of adjacent structures.
MRI: Appears T2 hyperintense, T1 hypointense, with no enhancement, no restricted diffusion, and findings consistent with a simple cyst.
Nuclear medicine: Technetium-99m pertechnetate scan may demonstrate radiotracer uptake in a portion of the cyst wall, consistent with the presence of ectopic gastric mucosa.
Treatment is usually unnecessary unless the patient is symptomatic.
Surgical resection is the most common treatment with excellent success.