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A 31-year-old male with dysphagia and chest pain presented to our hospital. CT demonstrated
a 6.3 × 3.7 cm low-density mass at the distal esophagus without enhancement. Endoscopic
ultrasound (EUS) confirmed a 5.0 × 4.0 cm hypoechoic cystic-solid mass covered by
smooth mucosal, part of the mass was associated with the esophageal muscle layer.
Color Doppler ultrasonography and ultrasound elastography demonstrated the mass lacked
blood flow and softness (Fig. 1). A minimally invasive treatment was appropriate after discussing. EUS served to
guide the incision site, after the muscle layer was cut by a dual knife, copious brown
mucinous fluid was drained from the cyst. A biopsy was taken from the cyst wall for
histopathologic examination. The cavity was sprayed with saline solution and lauromacrogol
in turn until the cyst wall turned white, then a few amounts of lauromacrogol remain
to ablate the cyst. Clips were used to close the incision. Histopathology revealed
a respiratory ciliated columnar epithelium-lined cyst wall, indicating the diagnosis
of a bronchogenic cyst. During 9 months of follow-up, the patient was asymptomatic,
endoscopy revealed the cyst was almost undetectable and CT suggested a considerable
decrease in lesion size (Fig. 2).
Fig. 1(a) A large low-density mass at the distal esophagus was observed on CT. (b) Endoscopy
revealed a semispherical swelling covered by smooth mucosal. (c) EUS confirmed a hypoechoic
cystic-solid mass, which had a capsule and was divided into three cavities. (d) Color
Doppler ultrasonography demonstrated a lack of blood flows through the cyst. (e) Ultrasound
elastography demonstrated the mass was soft.
Fig. 2(a) Copious brown mucinous fluid was drained from the cyst. (b) Endoscopic view following
cyst incision. (c) A smooth cyst wall and connected cavities can be seen. (d) Clips
were used to close the incision. (e f) Histopathology revealed a respiratory ciliated
columnar epithelium-lined cyst wall. (g) Follow-up endoscopy revealed the cyst was
almost undetectable and only a linear scar and clips remained without any stenosis.
(h) CT suggested a considerable decrease in lesion size.
