대한흉부영상의학회 Weekly Chest Cases

Case No : 1037 Date 2017-09-11

Courtesy of Dong Hyeok Kang, Soyeoun Lim, Kwon, Woon-Jung / Ulsan University Hospital, Korea
Age/Sex 6 / F
Chief Complaintdysphagia and vomiting

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Diagnosis With Brief Discussion

Diagnosis: Esophageal duplication cyst
Radiologic Findings: Chest radiograph shows a oblong mass-like lesion with internal air-fluid level is located at the left paraspinal region. Axial enhanced CT scans show cystic mass with internal air-fluid levels, and suspicious enhancement along internal margin of the mass, mimicking mucosa. This lesion was incidentally found 4 years ago, but was asymptomatic, so it was considered as congenital pulmonary airway malformation (CPAM).
Video-assisted thoracoscopic surgery (VATS) was performed. There was intact jejunal mucosa, and ileal mucosa with clear Payers patch. So pathologically it was diagnosed as foregut duplication cyst with enteric proliferation.
Brief Review: Gastrointestinal tract duplication cysts are rare congenital gastrointestinal malformation in young patients and adults. They consist of foregut duplication cysts, small bowel duplication cysts, and large bowel duplication cysts. (1) Duplication cysts of congenital origin may be attached to the esophagus in a paraesophageal location or may be intramural. (2).
Bronchogenic and esophageal duplication cysts are thought to arise from abnormal budding of the embryonic foregut at 5-8 weeks gestation, although the exact embryonic origin of different types of duplication cysts remains a mystery. (3) Of note, 50-70% of foregut duplication cysts are enterogenous while 7-15% of them are bronchogenic. (4)
Radiologic findings are often non-specific. Chest radiographs may show a middle or posterior mediastinal mass. Foregut duplication cysts constitute 6-15% of primary mediastinal masses. Barium swallow examination may demonstrate a smooth, rounded impression on the esophagus. (5).
Typical CT finding of esophageal duplication cyst is a homogeneous, low-attenuation mass with smooth borders (6). Although CT cannot definitely differentiate an esophageal duplication cyst from other benign paraesophageal lesions such as abscess, old hematoma, neurofibroma, lipoma, leiomyoma, or other foregut duplications, it can often suggested as a presumptive diagnosis (7).
References: 1. Roy Liu and Douglas G. Adler. Duplication cysts: Diagnosis, management, and the role of endoscopic ultrasound. Endosc Ultrasound. 2014 Jul-Sep; 3(3): 152–160.
2. Spjut HJ. Pathology. Dodds WJ. Radiology. In: Margulis AR, Burhenne HJ, eds. Alimentary tract radiology. St. Louis; Mosby, 1983: 521-528, 529-603.
3. Nobuhara KK, Gorski YC, La Quaglia MP, et al. Bronchogenic cysts and esophageal duplications: Common origins and treatment. J Pediatr Surg. 1997;32:1408–13.
4. Whitaker JA, Deffenbaugh LD, Cooke AR. Esophageal duplication cyst. Case report. Am J Gastroenterol. 1980;73:329–32
5. Feguson CC, Young LN, Sutherland JB, Macpherson RI. Intrathoracic gastrogenic cyst-preoperative diagnosis by technetium scan. J Pediatr Surg 1973; 8: 827-828.
6. Weiss L, Fragelman D, Warhit JM. CT demonstration of an esophageal duplication cyst. J Comput Assist Tomogr 1983; 7: 716-718.
7. Kuhlman JE, Fishman EK, Wang KP, Siegelman SS. Esophageal duplication cyst: CT and transesophageal needle aspiration. Am J Roentgenol 1985; 145: 531-532.
Please refer to: Case 552 Case 152
Keywords: Esophageal duplication cyst, Posterior mediastinum, Foregut malformation,

No. of Applicants : 105

▶ Correct Answer : 16/105, 15.2%

- Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
- Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
- Niigata University , Japan ATSUSHI UEHARA
- McGill University Health Center , Canada Alexandre Semionov
- Ajou university hospital , Korea (South) Pae Sun Suh
- Dammam Medical Tower - Saudi Araiba , Saudi Arabia HANAN ALKHATIB
- Dong-A University, College of Medicine , Korea (South) KI-NAM LEE
- Samsung Medical Center , Korea (South) KYOWON GU
- University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
- Busan National University Hospital , Korea (South) CHANGMU LEE
- Azienda Ospedaliera di Cremona , Italy Pietro Sergio
- The University of Tokyo Hospital , Japan TAKU TAJIMA
- District TB centre, kasaragod,India , India rikhy krishnan
- Ajou University Hospital , Korea (South) SEULGI YOU
- Teikyo University Hospital , Japan KAORU SUMIDA
- Ichinomiya Nishi Hospital , Japan Takao Kiguchi

▶ Correct Answer as Differential Diagnosis : 19/105, 18.1%

- Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
- University Hospitals Cleveland Medical Center , United States AMIT GUPTA
- The University of Tokyo Hospital , Japan Akifumi Hagiwara
- IRSA LA ROCHELLE , France, Metropolitan BIGOT
- Other , Korea (South) SEONG SU KANG
- Azienda Ospedaliera Universitaria Integrata di Verona , Italy GIAN ALBERTO SOARDI
- Ajou University School of Medicine , Korea (South) YOOLIM BAEK
- Onomichi municipal hospital , Japan Hirofumi Mifune
- Ajou University Hospital , Korea (South) Taeyang Ha
- Yonsei University, Wonju Severance Christian Hospital , Korea (South) JUYEON LEE
- MAGNUM DIAGNOSTICS - Goa INDIA , India PARESH K DESAI
- Mallinckrodt Institute of Radiology , United States Naganathan BS Mani
- Other , Korea (South) HAYEON LEE
- University of New South Wales , Australia RASHID HASHMI
- Fortis hospital , Mohali , India SHALEEN RANA
- Ajou University Hospital , Korea (South) SUBIN HEO
- Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
- Pusan national university hospital , Korea (South) Jin Joo Kim
- Ajou University Hospital , Korea (South) YONG HO JANG

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1037 Date 2017-09-11

Discussion

No. of Applicants : 105