Esophageal duplication cyst

Last revised by Yaïr Glick on 3 Jan 2023

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.

Esophageal duplication cysts typically present in childhood, can occur anywhere along the esophagus, and are usually asymptomatic. The majority (about 90%) do not communicate with the oesopageal lumen. More than half occur in the lower third of the esophagus 4, where they can cause dysphagia due to compression. There have also been reports of lower esophageal duplication cysts causing cardiac arrhythmias. Esophageal cysts occuring in the upper two thirds of the esophagus can cause upper respiratory symptoms (e.g. cough, wheezing, stridor) and resrosternal chest pain.

They are a congenital malformation of the posterior primitive foregut and result from an aberration of the posterior division of the embryonic foregut at 3-4 weeks gestation. They comprise two outer muscle layers and an inner epithelial lining which is variable and can include stratified squamous, simple columnar, pseudostratified columnar, cuboidal, and ciliated epithelium; there are even reports of intermixed heterotopic gastric or pancreatic mucosa.

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 structure with internal fluid density along the esophagus. Its wall may be slightly thicker than a bronchogenic cyst.

  • T1: low to intermediate signal intensity

  • T2: high signal intensity

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:

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

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Cases and figures

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  • Case 2
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  • Case 3: superior mediastinal mass
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  • Case 3
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  • Case 4
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