esophageal duplication
Duplication of the esophagus has a range of macroscopic appearances from complete (very rare) to partial cystic duplication (esophageal duplication cyst). It is the second most common gastrointestinal tract duplication after that of the ileum.
Epidemiology
A complete duplication is a rare malformation and is also often associated with a gastric duplication (also rare). A partial duplication is more common. As a congenital abnormality, it is usually identified soon after birth, if symptomatic.
Clinical presentation
Presentation of large duplication cysts usually occurs in the newborn or infant, with symptoms referable to pressure on the adjacent lung or esophagus, leading to:
- respiratory difficulties
- dysphagia
- vomiting
Smaller cysts can be asymptomatic and are usually found incidentally at imaging.
Pathology
The duplicated segment has a thick wall of smooth muscle and is lined with alimentary tract mucosa. The lining mucosa may be the same as that in the segment it parallels, or may be similar to the mucosa lining some other portion of the alimentary tract - frequently, gastric mucosa, in which case peptic ulceration of the duplication is a common finding.
Radiographic features
Most often, duplications are spherical cysts that rarely make an impression on the esophagus and are usually located in the right hemithorax.
Plain radiograph
On plain chest radiographs, they are usually seen as rounded fluid / soft tissue density posterior mediastinal masses.
Fluoroscopy
In cystic esophageal duplication, the esophagogram shows the esophagus to be displaced to the side opposite the mass (i.e. contralaterally).
CT
Duplication cysts appear as sharply marginated masses with homogeneous fluid density. No enhancement is visible after intravenous contrast administration.
MRI
MRI demonstrates features of a cyst. Signal characteristics therefore include:
- T1: low signal
- T2: high signal
- T1 C+ (Gd): no solid enhancement
Differential diagnosis
For a partial cystic duplication consider any posterior or middle mediastinal mass, including:
- neoplasms arising from the sympathetic chain: ganglioglioma, ganglioneuroma, etc
- bronchogenic cyst
- the distinction between this entity and esophageal duplication cysts is often impossible on imaging alone, and can only be settled by obtaining histology, which is not normally done
- furthermore, in asymptomatic patients the distinction is of no real clinical relevance
- pericardial cyst
- neurenteric cyst
- pulmonary sequestration
- anterior meningocele
- hemangioma
Siehe auch:
- Bronchogene Zyste
- Perikardzyste
- Lungensequester
- Hämangiom
- neuroenterische Zyste
- Duplikationszysten gastrointestinal
- Duplikationszyste des Ösophagus
- benignes Ganglioneurom
und weiter:
Assoziationen und Differentialdiagnosen zu Ösophagusduplikatur:
