Esophageal duplication

Changed by Yaïr Glick, 3 Sep 2018

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Duplication of the oesophagus has a range of macroscopic appearances, ranging from complete (which is very(very rare) to partial cystic duplication (oesophageal duplication cyst). It is the second most common gastrointestinal tract duplication after that of the ileum.

Epidemiology

A complete duplication is a rare malformation, and is also often associated with a gastric duplication(also rare). A partial duplication is more common. As a congenital abnormality, if symptomatic, it is usually identified soon after birth, if symptomatic.

Clinical presentation

Presentation of large duplication cysts is usuallyusually occurs in the newborn or infant, with symptoms referable to pressure on the adjacent lung or oesophagus, leading to:

  • respiratory difficulties
  • dysphagia
  • vomiting

Smaller cysts can be asymptomatic and onlyare usually found incidentally at any timeimaging

Pathology

The duplicated segment has a thick wall of smooth muscle and is lined with alimentary tract mucosa. The lining mucosa may be the same as that in the segment it parallels, or it may be similar to that inthe mucosa lining some other portionsportion of the alimentary tract, - frequently, gastric mucosa, in which case peptic ulceration of the duplication is a common finding.

Radiographic features

Most often, duplications are spherical cysts that rarely make an impression on the oesophagus and are usually located in the right hemithorax.

Plain radiograph

On plain chest radiographs, they are usually seen as rounded fluid / soft tissue density posterior mediastinal masses.

Fluoroscopy

In cystic oesophageal duplication, the oesophagogram shows the oesophagus to be displaced to the side opposite the mass (i.e. contralaterally).

CT

Duplication cysts appear as is sharply marginated masses with homogeneous fluid density. No enhancedenhancement is visible after intravenous contrast administration is visible.

MRI

MRI demonstrates features of a cyst:. Signal characteristics therefore include:

  • T1: low signal
  • T2: high signal
  • T1 C+ (Gd): no solid enhancement

Differential diagnosis

For a partial cystic duplication consider any posterior or middle mediastinal mass, including: 

  • -<p><strong>Duplication of the oesophagus</strong> has a range of macroscopic appearances, ranging from complete (which is very rare) to partial cystic duplication (<a href="/articles/oesophageal-duplication">oesophageal duplication cyst</a>). It is the second most common gastrointestinal tract duplication after that of the ileum.</p><h4>Epidemiology</h4><p>A complete duplication is a rare malformation, and is also often associated with a <a href="/articles/gastric-duplication-cyst">gastric duplication</a><a href="/articles/gastric-duplication"> </a>(also rare). A partial duplication is more common. As a congenital abnormality, if symptomatic, it is usually identified soon after birth. </p><h4>Clinical presentation</h4><p>Presentation of large duplication cysts is usually in the newborn or infant, with symptoms referable to pressure on the adjacent lung or oesophagus, leading to:</p><ul>
  • +<p><strong>Duplication of the oesophagus</strong> has a range of macroscopic appearances from complete (very rare) to partial cystic duplication (<a href="/articles/oesophageal-duplication">oesophageal duplication cyst</a>). It is the second most common gastrointestinal tract duplication after that of the ileum.</p><h4>Epidemiology</h4><p>A complete duplication is a rare malformation and is also often associated with a <a href="/articles/gastric-duplication-cyst">gastric duplication</a> (also rare). A partial duplication is more common. As a congenital abnormality, it is usually identified soon after birth, if symptomatic.</p><h4>Clinical presentation</h4><p>Presentation of large duplication cysts usually occurs in the newborn or infant, with symptoms referable to pressure on the adjacent lung or oesophagus, leading to:</p><ul>
  • -<li>dysphagia</li>
  • +<li><a title="Dysphagia" href="/articles/dysphagia">dysphagia</a></li>
  • -</ul><p>Smaller cysts can be asymptomatic and only found incidentally at any time. </p><h4>Pathology</h4><p>The duplicated segment has a thick wall of smooth muscle and is lined with alimentary tract mucosa. The lining mucosa may be the same as that in the segment it parallels, or it may be similar to that in some other portions of the alimentary tract, frequently gastric mucosa, in which case peptic ulceration of the duplication is a common finding.</p><h4>Radiographic features</h4><p>Most often, duplications are spherical cysts that rarely make an impression on the oesophagus and are usually located in the right hemithorax.</p><h5>Plain radiograph</h5><p>On plain chest radiographs, they are usually seen as rounded fluid / soft tissue density <a href="/articles/posterior-mediastinal-mass-differential-diagnosis-1">posterior mediastinal masses</a>.</p><h5>Fluoroscopy</h5><p>In cystic oesophageal duplication, the oesophagogram shows the oesophagus to be displaced to the side opposite the mass.</p><h5>CT</h5><p>Duplication cysts appear as is sharply marginated masses with homogeneous fluid density. No enhanced after intravenous contrast administration is visible.</p><h5>MRI</h5><p>MRI demonstrates features of a cyst: Signal characteristics therefore include:</p><ul>
  • +</ul><p>Smaller cysts can be asymptomatic and are usually found incidentally at imaging. </p><h4>Pathology</h4><p>The duplicated segment has a thick wall of smooth muscle and is lined with alimentary tract mucosa. The lining mucosa may be the same as that in the segment it parallels, or may be similar to the mucosa lining some other portion of the alimentary tract - frequently, gastric mucosa, in which case <a title="Peptic ulceration" href="/articles/peptic-ulcer-disease">peptic ulceration</a> of the duplication is a common finding.</p><h4>Radiographic features</h4><p>Most often, duplications are spherical cysts that rarely make an impression on the oesophagus and are usually located in the right hemithorax.</p><h5>Plain radiograph</h5><p>On plain chest radiographs, they are usually seen as rounded fluid / soft tissue density <a href="/articles/posterior-mediastinal-mass-differential-diagnosis-1">posterior mediastinal masses</a>.</p><h5>Fluoroscopy</h5><p>In cystic oesophageal duplication, the oesophagogram shows the oesophagus to be displaced to the side opposite the mass (i.e. contralaterally).</p><h5>CT</h5><p>Duplication cysts appear as sharply marginated masses with homogeneous fluid density. No enhancement is visible after intravenous contrast administration.</p><h5>MRI</h5><p>MRI demonstrates features of a cyst. Signal characteristics therefore include:</p><ul>
  • -</ul><h4>Differential diagnosis</h4><p>For a partial cystic duplication consider any posterior or middle mediastinal mass, including: </p><ul>
  • +</ul><h4>Differential diagnosis</h4><p>For a partial cystic duplication consider any <a title="Posterior mediastinal mass (differential diagnosis)" href="/articles/posterior-mediastinal-mass-differential-diagnosis-1">posterior</a> or <a title="Middle mediastinal mass" href="/articles/middle-mediastinal-mass">middle mediastinal mass</a>, including: </p><ul>
  • -<li>the distinction between this entity and oesophageal duplication cysts is often not possible on imaging, and only is settled in the unusual setting of histology being obtained</li>
  • +<li>the distinction between this entity and oesophageal duplication cysts is often impossible on imaging alone, and can only be settled by obtaining histology, which is not normally done</li>
  • -<li><a href="/articles/neurenteric-cyst">neurenteric cyst</a></li>
  • +<li><a href="/articles/spinal-neurenteric-cysts">neurenteric cyst</a></li>
  • -<li><a href="/articles/anterior-meningocoele">anterior meningocoele</a></li>
  • +<li><a href="/articles/anterior-meningocoele">anterior meningocele</a></li>

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