esophageal duplication cyst

Esophageal duplication cysts are a type of congenital foregut duplication cyst.

Epidemiology

Less common compared to other foregut duplication cysts. There may be an increased male predilection .

Clinical presentation

Patients are generally asymptomatic but may complain of dysphagia due to esophageal compression. They typically present in childhood.

Pathology

They are a congenital malformation of the posterior primitive foregut and results from an aberration of the posterior division of the embryonic foregut at 3-4 weeks gestation. They are commonly lined by gastric epithelium. This ectopic gastric mucosa is prone to infection, perforation and hemorrhage.

Location

It mainly occurs in the thoracic esophagusand are more common on the right particularly in the distal esophagus.

Associations

Radiographic features

Plain radiograph

Well defined soft tissue density in close association with the esophagus.

Fluoroscopy

On barium swallow, the cyst may cause extrinsic compression of the esophagus.

CT

Well defined thick-walled structure with internal fluid density noted along the esophagus.

MRI
  • T1: low to intermediate signal intensity
  • T2: high signal intensity

Treatment and prognosis

Surgical resection is the mainstay of management . Prognosis tends to be very good as recurrence is rare .

Complications

Recognized complications include carcinoma arising within the cyst . If gastric mucosa is present, peptic ulceration may occur. Very occasionally they may perforate, hemorrhage or erode into adjacent structures.

Differential diagnosis

For uncomplicated cysts consider:

For complicated cysts (e.g. with hemorrhage/necrosis) the differential can be broader and can include:

See also