Esophageal duplication cysts are a type of congenital foregut duplication cyst.
Less common compared to other foregut duplication cysts. There may be an increased male predilection 5.
Patients are generally asymptomatic but may complain of dysphagia due to esophageal compression. They typically present in childhood.
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.
It mainly occurs in the thoracic esophagus 4 and are more common on the right particularly in the distal esophagus.
Well defined soft tissue density in close association with the esophagus.
On barium swallow, the cyst may cause extrinsic compression of the esophagus.
Well defined thick-walled structure with internal fluid density noted along the esophagus.
- T1: low to intermediate signal intensity
- T2: high signal intensity
Treatment and prognosis
Surgical resection is the mainstay of management 8. Prognosis tends to be very good as recurrence is rare 8.
Recognized complications include carcinoma arising within the cyst 5. If gastric mucosa is present, peptic ulceration may occur. Very occasionally they may perforate, hemorrhage or erode into adjacent structures.
For uncomplicated cysts consider:
- congenital cysts and malformations in the region
- cervical lymphadenopathy
- esophageal malignancy
- pancreatic pseudocyst: for retroperitoneal bronchogenic cysts or for pancreatic pseudocysts that extend intrathoracically through the aortic or esophageal hiatus
For complicated cysts (e.g. with hemorrhage/necrosis) the differential can be broader and can include:
- enlarged lymph nodes (especially centrally necrotic)
- pulmonary masses
- esophageal malignancy
- 1. Callahan MJ, Taylor GA. CT of the pediatric esophagus. AJR Am J Roentgenol. 2003;181 (5): 1391-6. doi:10.2214/ajr.181.5.1811391 - Pubmed citation
- 2. Kuhlman JE, Fishman EK, Wang KP et-al. Esophageal duplication cyst: CT and transesophageal needle aspiration. AJR Am J Roentgenol. 1985;145 (3): 531-2. doi:10.2214/ajr.145.3.531 - Pubmed citation
- 3. Grainger & Allison's diagnostic radiology essentials. Churchill Livingstone. ISBN:0702034487. Read it at Google Books - Find it at Amazon
- 4. Zhang Z, Jin F, Wu H et-al. Double esophageal duplication cysts, with ectopic gastric mucosa: a case report. J Cardiothorac Surg. 2013;8 (1): 221. doi:10.1186/1749-8090-8-221 - Pubmed citation
- 5. Jacob R, Hawkes ND, Dallimore N et-al. Case report: Squamous carcinoma in an oesophageal foregut cyst. Br J Radiol. 2003;76 (905): 343-6. Pubmed citation
- 6. Wiechowska-Kozłowska A, Wunsch E, Majewski M et-al. Esophageal duplication cysts: endosonographic findings in asymptomatic patients. World J. Gastroenterol. 2012;18 (11): 1270-2. doi:10.3748/wjg.v18.i11.1270 - Free text at pubmed - Pubmed citation
- 7. Rangasami R, Chandrasekharan A, Archana L et-al. Case report: Antenatal MRI diagnosis of esophageal duplication cyst. Indian J Radiol Imaging. 2009;19 (1): 75-7. doi:10.4103/0971-3026.45350 - Free text at pubmed - Pubmed citation
- 8. Abu-Zaid A, Azzam A. Esophageal Duplication Cyst. (2014) New England Journal of Medicine. 11;371(24):e36.
Related Radiopaedia articles
- esophageal dysmotility
- esophageal tumors
- benign esophageal neoplasms
- malignant esophageal neoplasms
- gastro-esophageal reflux disease
- esophageal stricture