Esophageal duplication Cyst, an unusual cause of recurrent chest infections & stridor, missed as mimicking thymic shadow on chest radiographs

Abstract

Background: Esophageal duplication cyst is an uncommon condition but, it is essential to be considered in the differential diagnosis of chronic cough and wheezing among young children. Surgery is indicated in symptomatic cyst, as early as possible to prevent complication and potential malignant transformation. Aim- We reported this case, as knowledge of esophageal duplication cyst's clinical features, imaging findings and knowledge of their mimics may help radiologists & clinicians to arrive at the correct diagnosis as earliest possible. Imaging Findings: We reported a case of 9 year old male child, admitted with fever, cough & decreased oral intake. Child was on oral treatment for last 8 days with no relief. His history was significant for recurrent episodes of cough and wheeze. Chest X ray showed a well defined homogenous, broad based opacity, projecting towards right mediastinum with smooth lateral borders, same as thymic shadow. CECT chest revealed a cystic paratracheal, paraesophageal mediastinal mass with fluid attenuation of 25 to 35 HU in right mediastinum obstructing the right lateral wall of trachea and esophagus. Patient got operated, histopathological examination confirmed a diagnosis of esophageal duplication cyst. Conclusion: Chest radiographs are initial Investigation of choice, however it is inconclusive, as it may mimic a thymic shadow on chest radiograph. CECT is the preferred imaging tool for the diagnosis of EDC. Usual approach is to surgically excise these lesions.