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.
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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.