Computed tomography Congenital Abnormalities Duplication of ESOPHAGUS

An esophageal duplication, which is a foregut cyst, is the least common of all esophageal congenital abnormalities. Complete duplication is rare; some of these abnormalities are also associated with gastric duplication. Some duplications communicate with the esophageal lumen, although most do not. With a high superior communication they mimic a branchial pouch fistula. Some lie between the esophagus and trachea or extend into the mediastinum anteriorly.
A rare one is intraabdominal in location. Duplications are often incidental findings, although being lined by alimentary tract mucosa, they can ulcerate. Hemorrhage or secretions increase their size, with the larger ones then obstructing pulmonary vessels or a bronchus. In the very young they are prone to obstruct the esophageal lumen. Similar to other gut duplications, a rare adenocarcinoma and a leiomyosarcoma have developed in these duplications involved all layers and pleural surface.
Conventional radiography or a contrast study reveals an extrinsic or intramural mass adjacent to the esophageal lumen,most often in the lower third of the esophagus. Computed tomography and MRI confirm their cystic nature. They appear as sharply marginated, fluid-filled oval or spherical tumors (Fig. 1.1). Endoscopic US of one cyst showed contiguity of the esophageal muscularis propria with cyst wall muscle layers

A typical duplication is hypointense on T1- and hyperintense on T2-weighted images, although the T2 signal varies depending on cyst protein content. Postcontrast the cyst wall  enhances to varying degree; marked enhancement should suggest either inflammation or presence of gastric mucosa.
A rare cancer develops in a foregut cyst. 2-[18F]-fluoro-deoxy-D-glucose (FDG) positron emission tomography (PET) of a foregut cyst adenocarcinoma revealed numerous hypermetabolic regions consistent with metastases.
Esophageal duplication. Computed tomography (CT) reveals a cyst (arrow) adjacent to the distal esophagus. It did not communicate with the esophageal lumen. (Courtesy of Temil Tirkes, M.D., University of Pennsylvania.)jurnal radiology Tags:
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