Endoscopic ultrasound of esophageal duplication cyst

Excerpt

Esophageal duplication cysts constitute 10 % to 15 % of gastrointestinal (GI) duplication cysts. Foregut duplication cysts which include esophageal and bronchogenic constitute 6 % to 15 % of primary mediastinal masses [1]. The prevalence of esophageal duplications cysts is 0.0122 %. Around 80 % are diagnosed in childhood. Most are located in the right posterior inferior mediastinum. Two thirds are found in the lower third of esophagus. They are lined by alimentary (squamous or enteric) epithelium and are either attached to esophagus in a paraesophageal or intramural fashion [2]. Endoscopic ultrasound (EUS) is the diagnostic investigation of choice to investigate duplication cysts since it can distinguish between solid and cystic lesions. EUS shows duplication cysts as anechoic, homogenous lesions with regular margins arising from the submucosal layer or extrinsic to the gut wall. On EUS, duplication cyst wall usually consist of three–five layers and the internal contents may be anechoic or hypoechoic. EUS-fine needle aspiration (FNA) is usually reserved for lesions of indeterminate appearance, suspicious for malignancy, or atypical in appearance for duplication cysts [1]. The accompanying images are from a 60-year-old woman who presented with dyspepsia for 2 months. Her clinical examination was normal. Upper GI endoscopy revealed mild extrinsic compression of the lumen in lower esophagus with normal appearing overlying mucosa. Contrast-enhanced computed tomography of the chest showed a soft tissue mass in the right posterior inferior mediastinum. Linear EUS revealed a 2.8 cm × 4.4 cm heterogeneous echotextured lesion with anechoic component posteroinferior to the left atrium (Fig.1a, b). After antibiotic prophylaxis, EUS-FNA of the lesion was performed with a 22-gauge needle and fluid was aspirated (Fig. 1c). Histopathological examination revealed squamous epithelium confirming the diagnosis of duplication cyst. Patient was managed symptomatically with proton pump inhibitor.

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