Adult esophageal duplication preoperatively diagnosed by endoscopic ultrasonography and treated with thoracoscopic resection: a case report.
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Esophageal duplication is a rare congenital foregut-derived anomaly that is usually diagnosed during childhood. Adult cases are uncommon and are often discovered incidentally. Because imaging findings frequently resemble those of other mediastinal or esophageal submucosal tumors, establishing a definitive preoperative diagnosis remains challenging. Here, we report an adult case of esophageal duplication that was diagnosed preoperatively using endoscopic ultrasonography and successfully treated with minimally invasive thoracoscopic resection, with emphasis on its characteristic imaging features.A 69-year-old man was incidentally found to have a cystic lesion in the lower esophagus during follow-up for chronic obstructive pulmonary disease. Computed tomography revealed a well-demarcated mass measuring approximately 50 mm. Endoscopic ultrasonography demonstrated an intramural cystic lesion with homogeneous hypoechoic contents that was continuous with the muscularis propria. Notably, the muscular layer of the cyst was continuous with that of the native esophagus, forming a characteristic Y-shaped configuration, a finding considered typical of esophageal duplication. On the basis of these endoscopic ultrasonography findings, a preoperative diagnosis of esophageal duplication was established. Thoracoscopic excision of the duplication cyst was successfully performed with preservation of the native esophagus. Histopathological examination revealed a cyst lined with ciliated columnar epithelium and a two-layered smooth muscle wall, confirming the diagnosis. The postoperative course was uneventful, and the patient remains free of recurrence.This case highlights characteristic endoscopic ultrasonography findings, particularly Y-shaped muscular continuity, that enabled accurate preoperative diagnosis and differentiation from other mediastinal and subepithelial lesions, and demonstrates that thoracoscopic resection is a safe and minimally invasive treatment option for adult esophageal duplication.