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Cardiothoracic and Vascular Surgery

Cardiothoracic and Vascular Surgery Podium Presentation: Symptomatic Esophageal Duplication Cyst in a 65-year-old Male

ON-DEMAND
Participants should be aware of the following financial/non-financial relationships:
Jane Ohde, DO: Disclosure information not submitted.
Vilok G. Vijayanagar, DO: Disclosure information not submitted.
James Martin, MD: Disclosure information not submitted.
David Siegel, DO: Disclosure information not submitted.
Neil Kleman, DO: Disclosure information not submitted.
Rachel Cohen, DO: Disclosure information not submitted.
Introduction/Purpose: Esophageal duplication cysts are rare congenital anomalies of the gastrointestinal tract most commonly presenting in childhood. When found in adults they are most often symptomatic. There are rare reports of malignant transformation.

Methods or Case Description:

This is a 65-year-old male who presented with increasing dysphagia to solid foods. He was evaluated with computed tomography (CT) of the chest which showed a 4.5 x 4.3 x 3 cm exophytic mass arising from the right lateral aspect of the lower esophagus. The patient underwent an upper endoscopy with endoscopic ultrasound (EUS) for further workup of this mass. The ultrasound showed a 4.6 x 2.1 cm hypoechoic heterogeneous mass lesion with septations around the distal esophagus. FNA was performed which was nondiagnostic. A positron emission tomography (PET) scan was then performed which showed increased uptake in the lower portion of the thoracic esophagus. It was recommended the patient undergo surgical resection.


Outcomes: A right posterolateral thoracotomy was performed with complete excision of the cyst. The cyst was inadvertently entered during dissection and purulent fluid was encountered. This was sent for cultures which showed mixed respiratory flora with rare yeast likely a result of infection introduced from the FNA. Pathology of the specimen revealed an esophageal duplication cyst with chronic inflammation and abscess formation with no evidence of malignancy. 

Conclusion: Esophageal duplication cysts are rare and usually present in childhood however our patient presented in late adulthood with a symptomatic cyst. The cyst likely became infected secondary to the FNA performed during his workup. Esophageal duplication cysts typically have a characteristic appearance on EUS and do not need biopsy for diagnosis. The mainstay of treatment is surgical which is now increasing performed minimally invasively.

Learning Objectives:

  1. Describe the presentation and diagnostic workup for an esophageal duplication cyst.
  2. Recognize typical radiographic and endoscopic findings.
  3. Discuss the various therapeutic interventions and their indications.