CTICasesInfected Esophageal Duplication Cyst with Communication
Imaging findings
Plain radiographs and CT reveal a large, multi-lobed cystic lesion traversing the diaphragm from the upper abdomen into the chest, initially fluid-filled and gradually enlarging. Subsequent imaging during a presentation with chest pain showed an air-fluid level, wall thickening, and enhancement within the cyst, with the cyst appearing smaller, suggesting decompression. Although no communication was surgically confirmed, the superior portion was noted to extend into the esophageal submucosa. Pathology showed squamous mucosa.
Key takeaways
A large esophageal duplication cyst can present as a multi-lobed cystic mass traversing the diaphragm, mimicking other conditions like achalasia or pancreatic pseudocysts. These cysts can become infected, leading to air-fluid levels, wall thickening, and enhancement. Decompression and reduction in size of an infected cyst implies a communication with the gastrointestinal tract, even if not surgically evident, likely through the esophagus, allowing swallowed air in and fluid out.
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