- Gastrointestinal duplication cysts are relatively common congenital anomalies which are composed of fluid-filled sacs lined by a layer of epithelium and smooth muscle from the alimentary tract.
- They frequently share a common blood supply and muscular wall from the adjacent portion of the intestine. The most common locations are: Distal ileum (34%), esophagus (19%), stomach (9%), jejunum (9%), and appendix (6%), duodenum (5%).
- The most common type of duplication cyst is spherical in shape, and almost never communicates with the alimentary tract. The more rare tubular type commonly communicates with the GI tract, frequently resulting in superinfection.
- The distal 1/3 of the esophagus is the most common location for esophageal duplications. These duplications commonly contain gastric or pancreatic tissue. Gastric-mucosa containing intestinal duplications can ulcerate, causing hemorrhage and even perforation.
- Narrowing mediastinal lesions to a particular region of the mediastinum greatly refines the differential. For middle mediastinal masses: Bronchogenic cyst, esophageal duplication, neurenteric cyst, lymphangioma, mature cystic teratoma (dermoid).
SLIDES SHOW ESOPHAGEAL DUPLICATION CYST
Radiologic Findings:
- CXR or KUB: May appear as a mediastinal or abdominal mass. Look for displacement of trachea, bronchi, esophagus, other structures. May contain air-fluid levels if communication with GI tract (very rare, tubular type).
- CT: Thin walled, non-enhancing, density anywhere from fluid to soft tissue. Mass located adjacent to alimentary tract.. Oral contrast very helpful in delineating margins of duplication.
- Nuclear medicine: Tc-99m Pertechnetate scintigraphy will demonstrate intestinal duplications containing gastric mucosa.
References:
- Kirks et al, Practical Pediatric Imaging.
- Brandt, Helms et al. Fundamentals of Diagnostic Radiology. 2006, 3rd Ed.
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