N Engl J Med 2014; 371 December 11, 2014
Images in Clinical Medicine
An otherwise healthy 23-year-old man presented with a 3-week history of difficulty swallowing solid food and associated vomiting. He reported no history of respiratory symptoms or weight loss. A barium-swallow examination showed substantial luminal narrowing of the distal esophagus (Panel A, arrows), and a focal mass effect could be seen anteriorly on a second projection (Panel B, arrows). Computed tomography (CT) of the chest performed after the administration of contrast material showed a well-defined, bilobed, cystic mediastinal mass measuring 7.3 cm by 3.2 cm by 7.0 cm. The mass was contiguous with the distal esophagus (Panel C, white arrows), which was immediately posterior to the mass and was compressed by it (Panel C, with the red arrow pointing to the expected location of the esophagus). Neither internal enhancement nor invasion of surrounding structures was seen on CT. The findings were most consistent with an esophageal duplication cyst. The patient underwent surgical resection of the cyst, and there were no indications of recurrence on a CT image obtained at a 2-month follow-up visit. Esophageal duplication cysts are uncommon, benign mediastinal masses. Most cases are diagnosed in infancy or childhood and involve the distal third of the esophagus. Complete surgical excision is typically curative, since recurrence is rare.
Ahmed Abu-Zaid, M.B., B.S.
Alfaisal University College of Medicine, Riyadh, Saudi Arabia
Ayman Azzam, M.D., Ph.D.
Alexandria University Faculty of Medicine, Alexandria, Egypt