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Esophageal Duplication Cyst

General Considerations Rare mediastinal mass Most are diagnosed in childhood May be simple epithelial cysts or duplications that contain muscle and submucosa but not epithelium Most (60%) occur in lower 1/3 of esophagus Most commonly associated with difficulty swallowing Occur because of maldevelopment of the posterior division of embryonic foregut Clinical Findings May be asymptomatic and never diagnosed Symptoms are produced by compression of surrounding structures; larger cysts produce more symptoms Those that occur in cervical esophagus (20%) may produce respiratory problems most commonly Those that occur in mid-esophagus (20%) may cause retrosternal pain or dysphagia May present with hemorrhage if there is gastric mucosa in cyst Imaging Findings Most develop on the right side of esophagus, posteriorly and inferiorly Conventional radiography Sharply-marginated, middle mediastinal soft tissue mass CT scans Study of choice Well-marginated, usually round, oval or tubular-shaped, fluid-filled cystic structure Well-defined, thin wall Homogeneous water attenuation (0-20HU) No enhancement of cyst contents No infiltration of surrounding tissues Originates from esophagus MRI Typically dark on T1 and bright on T2-weighted images Differential Diagnosis Bronchogenic cysts (may have identical appearance to esophageal cysts) Neurenteric cysts Pericardial cysts Cystic teratoma Treatment Nearly ¾ with cysts will become symptomatic, so they are usually resected Simple cysts are enucleated Duplication cysts are excised Complications Complication rates from surgery are very low Malignant degeneration is rare but reported Prognosis Recurrence is rare

Esophageal Duplication Cyst. White arrows point to a middle mediastinal soft tissue mass with sharp margins on the conventional frontal radiograph. On the CT scan, the white arrow points to a fluid-filled, cystic mass to the right of the location of the esophagus. The mass measured water density . For more information, click on the link if you see this icon For these same photos without the annotations, click here and here

Esophageal Cysts. eMedicine. Dale K Mueller, MD. Imaging of Cystic Masses of the Mediastinum. Mi-Young Jeung, MD, Bernard Gasser, MD, Afshin Gangi, MD, PhD, Adriana Bogorin, MD, Dominique Charneau, MD, Jean Marie Wihlm, MD, Jean-Louis Dietemann, MD and Catherine Roy, MD. RadioGraphics, 22, S79-S93.