Foregut duplications including bronchogenic cysts, esophageal duplications and cysts, and neuroenteric cysts are relatively rare in children. Here we describe the thoracoscopic excision of an espophageal duplication cyst in an infant. A five-month-old infant presented with a cough and retrocardiac density on chest x-ray initially felt to be pneumonia. Follow up x-ray one month later revealed a larger, circumscribed density concerning for a mass lesion. A CT scan of the chest identified a 2.1 x 2.1 cm cystic lesion near the gastroesophageal junction within the left thorax. At age 7 months, the infant underwent left thoracoscopic excision of the lesion.

With the infant placed in the right lateral decubitus position and right mainstem intubation, three ports were used (1 x 5 mm and 2 x 4 mm). The mediastinal pleura overlying the lesion was incised using hook electrocautery. The integrity of the esophageal muscular coat was maintained throughout the dissection. The cyst was aspirated by placing an 18-gauge needle directly through the chest wall. The cyst was then removed intact through a slightly enlarged trocar site (4 mm -> 7 mm). A 10 French chest tube was left in place and an esophagram was performed on post-operative day #1 which revealed no leak. The chest tube was removed and the infant was discharged to home on post-operative day #2. One month following excision the infant was doing well and thriving. Esophageal duplications are uncommon in children but are amenable to excision using thoracoscopic techniques.