Foregut Cysts in Infants and Children

Abstract

The charts of 15 patients with foregut cysts were reviewed. The lesions were intrathoracic in 14 patients and in the cervical area in one child. The importance of early diagnosis and surgical management is stressed. In untreated infants with foregut cysts, severe progressive and life-threatening airway obstruction may develop. Since the symptoms of this congenital lesion may simulate other more common diseases of the tracheobronchial tree and esophagus, the physician should become familiar with this disease entity so that proper diagnosis and surgical treatment will not be delayed. The study includes symptomatology, methods of diagnosis, pathologic findings and classification of the cysts.

Esophageal duplication cyst: A rare cause of biphasic stridor and feeding difficulty

“…Takeda et al [11] found dyspnea and dysphagia as the most common presenting symptoms. Stridor in an infant caused by an esophageal duplication cyst is a rare presentation [14,15]. As was the case with our patient, esophageal duplication cysts rarely connect with the native esophagus, and only two reports were found with connection to the native esophageal lumen [2].…”

“…Because of the proximity of the lesion to the posterior tracheal wall, and the pliability of the soft tracheal cartilage, the mass provided enough compression to cause significant obstruction with subsequent respiratory difficulty and biphasic stridor. Our case further highlights the fact that esophageal cyst do not communicate with, or attached to the vertebral column [15], which differentiates esophageal from neuroenteric cyst.…”

“…Esophageal duplication cysts are rare anomalies resulting from foregut budding error during the third to sixth week of embryonic development [14,15]. The primitive foregut divides into ventral and dorsal segments, the former becomes the laryngotracheal tree which gives rise to the respiratory tract, the latter forming the esophagus [12].…”

“…Both classification systems help to define esophageal cyst, but has done little to clarify bronchogenic cyst. A differentiating factor is the finding of cartilage in the walls of bronchogenic cysts [8,12,15].…”

Completely intramural bronchogenic cyst of the cervical esophagus in a neonate

“…But when a cyst is large, symptoms reflective of respiratory or digestive tract compression may arise including dyspnea, respiratory distress, cough, or dysphagia [4,19]. However, when symptoms develop in early infancy, they are most likely to progress rapidly and produce airway obstruction [20] in the first instance. Although the cystic lesion in our case was completely intramural and located in the cervical esophagus, stridor was the presenting symptom.…”