Esophageal duplication cyst

Last revised by Dr Matt A. Morgan on 10 Sep 2022

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 result from an aberration of the posterior division of the embryonic foregut at 3-4 weeks gestation. They are lined by ciliated, pseudostratified, columnar epithelium. Mucinous columnar epithelium would make it bronchogenic cyst; a double smooth muscle layer is compatible with an esophageal duplication cyst.

They mainly occur 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 structure with internal fluid density noted along the esophagus. 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

  • Case 1
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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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