Transnasal Esophagoscopy and the Diagnosis of a Mediastinal Foregut Duplication Cyst

Abstract

A 61-year-old asymptomatic man was referred to the otolaryngology clinic at UCLA with a left paratracheal mass. The lesion had been found incidentally when the patient had undergone ultrasound to evaluate his carotid arteries. He denied any change in voice, dysphagia, shortness of breath, weight loss, or fevers. Upon physical examination, the patient had normal voice quality, normal vocal fold mobility, and no neck masses or lymphadenopat hy. Transnasal esophagoscopy (TNE) revealed a smooth compression of the left anterior wall of the esophagus superior to the aortic pulsation, mildly narrowing the esophageal lumen (figure 1). Computed tomography (CT) of the neck and chest revealed a lesion approximately 5 cm in diameter located between the trachea and esophagus (figure 2); however, the lesion did not directly involve either of these structures. Based on the constellation of imaging findings, a presumptive diagnosis of bronchogenic cyst was made, given the separation of the cyst from the esophageal wall; however, in the absence of histology, the differential diagnosis included esophageal duplication cyst. Foregut duplication cysts are true mucus-filled cysts lined with a thin epithelial layer, arising from either bronchogenic, esophageal, or neuroenteric precursor tissue; the cysts can be differentiate d from one another histologically by the identification of the tissuespecific epithelial phenotype. A rare entity, the foregut duplication cyst most often has been identified within the pediatrie population. It presents most commonly with respiratory distress and feeding difficulty in infants. Although uncommon, lesions may be discovered in older adults (age >60 years) either incidentally or as a result of newly developing symptoms, including