Esophageal duplication

Introduction Esophageal duplication means that the side attached to the esophageal wall has the same tissue morphology as a part of the digestive tract, and has a spherical or tubular cavity structure. Difficulty breathing, cyanosis, hemoptysis, blood in the stool, and difficulty swallowing without obvious incentives. During embryonic development, when the upper digestive tract evolves from the solid phase to the vacuole phase, its vacuolation process is disordered, failing to fuse with the normal digestive tract, and finally forming a single or polycystic sac in the chest, and The esophagus is closely connected, which becomes a repeat deformity of the esophagus.

Cause

During embryonic development, when the upper digestive tract evolves from the solid phase to the vacuole phase, its vacuolation process is disordered, failing to fuse with the normal digestive tract, and finally forming a single or polycystic sac in the chest, and The esophagus is closely connected, which becomes a repeat deformity of the esophagus. If a single vacuole remains, a round cyst-like repeat deformity is formed. If several vacuoles are strung together along the longitudinal axis of the esophagus, a lumen-like repeat deformity is formed.

an examination

Related inspection

Esophagography esophageal barium meal perspective

1. Clinical manifestations: dyspnea, cyanosis, hemoptysis, blood in the stool and difficulty in swallowing without obvious incentives. Physical examination: the affected side is full of thoracic, the intercostal space is widened, the main trachea is displaced, and a large deformed deformity in the neck can be seen on the side of the neck.

2. Auxiliary examination: prompt the mediastinal mass, compress the esophagus and trachea. Watersion's study of 50 cases of esophageal repetitive malformation pointed out that there are two important manifestations of this type of malformation in the diagnosis. One is that the esophageal repetitive malformation has more gastric mucosal tissue, and it is prone to ulceration, and even penetrates the wall of the tube into the trachea, causing hemoptysis. . Secondly, the deformity was repeated and the semi-vertebral deformity was merged.

Laboratory examination: The cyst fluid is taken for examination. The normal cyst fluid is light yellow, clear, slightly sticky, and the pH is acid. Dark brown or brown when there is old internal bleeding.

Other auxiliary inspections:

1. X-ray inspection:

(1) Chest flat: large esophageal repetitive deformity can be shown as a soft tissue mass shadow with uniform density and clear boundary in the posterior mediastinum, which widens or protrudes into the chest cavity and even occupies most of the chest. The trachea is displaced to the opposite side or the front, and the lumen sometimes becomes narrow.

(2) Esophageal barium angiography: visible curved indentation and advancement. A small number of cysts can be inflated or have a gas-liquid surface.

Repeated esophageal malformations can have the following forms:

1 semi-circular or triangular cyst: its long axis is consistent with the esophagus, and the triangular shadow cyst extends into the right middle and middle interlobular fissures, which is caused by the compression of the upper and middle lobe lungs. Semi-circular is the most common type, with sharp edges that can roughly occupy half of the chest and compress the surrounding lung tissue. The mediastinum is displaced to the opposite side.

2 neck and superior mediastinal cyst: semi-circular protrusion to the tip of the lung, compression of the trachea to the contralateral displacement, lateral radiograph showing thick tissue shadow of the posterior pharyngeal wall, tracheal lumen narrowing forward.

3 semi-goose-shaped cyst: when the right cyst is large, there is often a dent between the upper part and the lower part, like a gourd shape. May be caused by vascular compression.

4 inflatable cysts: This type of cyst is rare. Some authors report that 1 case is a 6-day baby boy. There is a huge thin-walled inflatable cyst in the right thoracic cavity. The lung tissue can be seen in the lung tip and rib angle. The cyst protrudes backwards and downwards, and the heart shadow shifts to the left. The preoperative diagnosis was "congenital pulmonary cyst". The operation and pathology confirmed the intrathoracic repeat deformity. It contained milk blocks and green liquid, which was connected with the underarm duodenum.

5) The mediastinal soft tissue shadow is widened and extends to the underarm to connect with the gastric cyst.

6 tuning fork type esophagus: the repeat esophagus is tubular in parallel with the normal esophagus, and the lower part is converged. Can be combined with hiatal hernia, reflux esophagitis and esophageal stricture. There is no block shadow in the mediastinum. In some cases, vertebral malformation (vertebral canal fissure, semi-vertebral body more common), lung non-development, esophageal atresia, intra-abdominal repeat deformity, etc., have great significance for diagnosis.

2. B-ultrasound and CT examination: it has important reference value for distinguishing the nature of the tumor (cystic or solid).

3. Fiber esophagoscopy: visible swelling into the esophageal cavity, generally do not microscopic examination, so as not to cause tissue adhesions affect surgery.

Differential diagnosis

The disease needs to be differentiated from empyema, intrathoracic teratoma, intrapulmonary tumor, bronchial cyst, neurogenic tumor and anterior spinal dural bulging.

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