Monday, January 19, 2009

Discussion Case- Gastroinstinal Radiology




53 yr ol lady being treated for mediatinal Lymphnodal TB at premier hospital in Delhi, has no change in finding over 2 yrs We would like comments and they will be displayed here Please support diagnosis with relevant literature. If we recieve a good rersponse to this case we will post more such teasers.


Our Opinion-when a lesion remains static with no change we need to get on with other structures in the nighbourhood The lesion is likely to represent oesophageal duplication cyst with a d/d of leiomyoma . Unfortunately in both the conditions endoscopy does not score. We tried oral contrast and it does not go there that does not exclude the possiblility These are uncommon and constitute only 0.5 - 2.5 % of all esophageal tumors . Of duplication cysts, 60% are located in the lower esophagus. mid third shows 20%, can be paraoesophageal or intramural in location.
Result from developmental errors occurring at the fifth to eight week of life and are believed to represent a failure of complete vacuolation of the originally solid esophagus to produce a hollow tube. They are lined by nonkeratinizing squamous or ciliated columnar epithelium: a double layer of smooth muscle in their walls and absence of cartilage are necessary findings to exclude a diagnosis of bronchial cyst radiologically it shows up as smooth appx 5 cm diameter hypodense mass nonenhancing after i v contrast. d/d includes abscess, old hematoma, neurofibroma, lipoma, leiomyoma, or other foregut duplications

Ref; 1.Weiss L, Fragelman D, Warhit JM. CT demonstration of an esophageal duplication cyst. J Comput Assist Tomogr 1983; 7: 716-718.regs

Case submitted by-
Dr MGK Murthy, Sr Consultant Radiologist

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