Learning Radiology xray montage

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


  • Nearly ¾ with cysts will become symptomatic, so they are usually resected
  • Simple cysts are enucleated
  • Duplication cysts are excised


  • Complication rates from surgery are very low
  • Malignant degeneration is rare but reported


  • Recurrence is rare 

Esophageal duplication cystEsophageal duplication cyst

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.