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Congenital Anomalies of the Tracheobronchial Tree, Lung, and Mediastinum: Embryology, Radiology, and Pathology¹

¹ From the Department of Pediatric Radiology, Hospital Infantil La Paz, 261 Paseo de la Castellana, 28046 Madrid, Spain. Presented as an educational exhibit at the 2002 RSNA scientific assembly. Received April 21, 2003, revision requested July 2, revision received and accepted August 13. Address correspondence to T.B. (e-mail: cprieto@hulp.insalud.es).

View larger version (112K): [in a new window]   Figure 1a.  Tracheomalacia. (a) Radiograph of the trachea in a 2-month-old infant with stridor shows marked diffuse tracheal narrowing during expiration (arrows). (b, c) Radiographs of a 3-week-old infant with Hurler disease. The trachea (arrows) was noted to be persistently narrowed in all studies.

View larger version (83K): [in a new window]   Figure 1b.  Tracheomalacia. (a) Radiograph of the trachea in a 2-month-old infant with stridor shows marked diffuse tracheal narrowing during expiration (arrows). (b, c) Radiographs of a 3-week-old infant with Hurler disease. The trachea (arrows) was noted to be persistently narrowed in all studies.

View larger version (111K): [in a new window]   Figure 1c.  Tracheomalacia. (a) Radiograph of the trachea in a 2-month-old infant with stridor shows marked diffuse tracheal narrowing during expiration (arrows). (b, c) Radiographs of a 3-week-old infant with Hurler disease. The trachea (arrows) was noted to be persistently narrowed in all studies.

View larger version (80K): [in a new window]   Figure 2a.  Tracheal stenosis. (a) Posteroanterior and (b) lateral radiographs of the upper airways show narrowing of the tracheal lumen in the subglottic trachea (arrows). (c) Curvilinear coronal reformation of CT scan shows the narrowed segment (arrows) (1 = craniocaudal length of the stenosis, 2 = transverse diameter of the tracheal lumen at the stenosis). (d) Posteroanterior radiograph of the trachea in another patient, obtained with filtered high-kilovoltage technique, shows two tracheal narrowings (arrows).

View larger version (108K): [in a new window]   Figure 2b.  Tracheal stenosis. (a) Posteroanterior and (b) lateral radiographs of the upper airways show narrowing of the tracheal lumen in the subglottic trachea (arrows). (c) Curvilinear coronal reformation of CT scan shows the narrowed segment (arrows) (1 = craniocaudal length of the stenosis, 2 = transverse diameter of the tracheal lumen at the stenosis). (d) Posteroanterior radiograph of the trachea in another patient, obtained with filtered high-kilovoltage technique, shows two tracheal narrowings (arrows).

View larger version (97K): [in a new window]   Figure 2c.  Tracheal stenosis. (a) Posteroanterior and (b) lateral radiographs of the upper airways show narrowing of the tracheal lumen in the subglottic trachea (arrows). (c) Curvilinear coronal reformation of CT scan shows the narrowed segment (arrows) (1 = craniocaudal length of the stenosis, 2 = transverse diameter of the tracheal lumen at the stenosis). (d) Posteroanterior radiograph of the trachea in another patient, obtained with filtered high-kilovoltage technique, shows two tracheal narrowings (arrows).

View larger version (126K): [in a new window]   Figure 2d.  Tracheal stenosis. (a) Posteroanterior and (b) lateral radiographs of the upper airways show narrowing of the tracheal lumen in the subglottic trachea (arrows). (c) Curvilinear coronal reformation of CT scan shows the narrowed segment (arrows) (1 = craniocaudal length of the stenosis, 2 = transverse diameter of the tracheal lumen at the stenosis). (d) Posteroanterior radiograph of the trachea in another patient, obtained with filtered high-kilovoltage technique, shows two tracheal narrowings (arrows).

View larger version (85K): [in a new window]   Figure 3a.  Tracheal bronchus. (a) Drawing shows the most frequent origin of the tracheal bronchus (arrows). (b) CT section demonstrates a right-upper-lobe bronchus (arrows) arising from the trachea, above the carina. (c) CT scan of the same patient at the level of the carina, 2 cm below the origin of the tracheal bronchus. (d) Bronchogram helps confirm the diagnosis and shows the origin of the tracheal bronchus. Rib alterations in the right hemithorax are secondary to prior thoracotomy.

View larger version (64K): [in a new window]   Figure 3b.  Tracheal bronchus. (a) Drawing shows the most frequent origin of the tracheal bronchus (arrows). (b) CT section demonstrates a right-upper-lobe bronchus (arrows) arising from the trachea, above the carina. (c) CT scan of the same patient at the level of the carina, 2 cm below the origin of the tracheal bronchus. (d) Bronchogram helps confirm the diagnosis and shows the origin of the tracheal bronchus. Rib alterations in the right hemithorax are secondary to prior thoracotomy.

View larger version (66K): [in a new window]   Figure 3c.  Tracheal bronchus. (a) Drawing shows the most frequent origin of the tracheal bronchus (arrows). (b) CT section demonstrates a right-upper-lobe bronchus (arrows) arising from the trachea, above the carina. (c) CT scan of the same patient at the level of the carina, 2 cm below the origin of the tracheal bronchus. (d) Bronchogram helps confirm the diagnosis and shows the origin of the tracheal bronchus. Rib alterations in the right hemithorax are secondary to prior thoracotomy.

View larger version (152K): [in a new window]   Figure 3d.  Tracheal bronchus. (a) Drawing shows the most frequent origin of the tracheal bronchus (arrows). (b) CT section demonstrates a right-upper-lobe bronchus (arrows) arising from the trachea, above the carina. (c) CT scan of the same patient at the level of the carina, 2 cm below the origin of the tracheal bronchus. (d) Bronchogram helps confirm the diagnosis and shows the origin of the tracheal bronchus. Rib alterations in the right hemithorax are secondary to prior thoracotomy.

View larger version (109K): [in a new window]   Figure 4a.  Bronchial atresia (a) CT scan shows air trapping in the right upper lobe (arrows). (b) CT scan in the same patient shows a round opacity at the site of the atresia, medial to the air trapping, representing mucoid impaction just distal to the atresia.

View larger version (107K): [in a new window]   Figure 4b.  Bronchial atresia (a) CT scan shows air trapping in the right upper lobe (arrows). (b) CT scan in the same patient shows a round opacity at the site of the atresia, medial to the air trapping, representing mucoid impaction just distal to the atresia.

View larger version (156K): [in a new window]   Figure 5a.  Bronchogenic cyst. (a) Chest radiograph of an asymptomatic 5-year-old girl shows a large soft-tissue mass in the right hemithorax (arrows). (b) Contrast material-enhanced CT scan through the upper lobes shows a well-defined water-density homogeneous mass (*) with no contrast enhancement.

View larger version (106K): [in a new window]   Figure 5b.  Bronchogenic cyst. (a) Chest radiograph of an asymptomatic 5-year-old girl shows a large soft-tissue mass in the right hemithorax (arrows). (b) Contrast material-enhanced CT scan through the upper lobes shows a well-defined water-density homogeneous mass (*) with no contrast enhancement.

View larger version (134K): [in a new window]   Figure 6a.  Complicated bronchogenic cyst. (a) Chest radiograph shows rounded mass with an air-fluid level, occupying the entire right middle lobe, corresponding to a bronchogenic cyst connecting with the bronchus. (b) Contrast-enhanced CT scan shows a thick-walled fluid-filled rounded mass (*) with an air-fluid level, corresponding to the infected bronchogenic cyst. Note enhancement of the cystic wall.

View larger version (120K): [in a new window]   Figure 6b.  Complicated bronchogenic cyst. (a) Chest radiograph shows rounded mass with an air-fluid level, occupying the entire right middle lobe, corresponding to a bronchogenic cyst connecting with the bronchus. (b) Contrast-enhanced CT scan shows a thick-walled fluid-filled rounded mass (*) with an air-fluid level, corresponding to the infected bronchogenic cyst. Note enhancement of the cystic wall.

View larger version (88K): [in a new window]   Figure 7a.  Lung agenesis. (a) Schematic of lung agenesis. (b) Posteroanterior and (c) lateral radiographs of a 5-year-old boy with complete opacity of the right hemithorax and displacement of the heart and mediastinum to the right. Note the tracheal displacement to the right. (d) Bronchography and (e) pulmonary angiography in the same patient demonstrate complete absence of the main right pulmonary bronchus and artery, with normal left arteries and bronchial branches

View larger version (165K): [in a new window]   Figure 7b.  Lung agenesis. (a) Schematic of lung agenesis. (b) Posteroanterior and (c) lateral radiographs of a 5-year-old boy with complete opacity of the right hemithorax and displacement of the heart and mediastinum to the right. Note the tracheal displacement to the right. (d) Bronchography and (e) pulmonary angiography in the same patient demonstrate complete absence of the main right pulmonary bronchus and artery, with normal left arteries and bronchial branches

View larger version (136K): [in a new window]   Figure 7c.  Lung agenesis. (a) Schematic of lung agenesis. (b) Posteroanterior and (c) lateral radiographs of a 5-year-old boy with complete opacity of the right hemithorax and displacement of the heart and mediastinum to the right. Note the tracheal displacement to the right. (d) Bronchography and (e) pulmonary angiography in the same patient demonstrate complete absence of the main right pulmonary bronchus and artery, with normal left arteries and bronchial branches

View larger version (175K): [in a new window]   Figure 7d.  Lung agenesis. (a) Schematic of lung agenesis. (b) Posteroanterior and (c) lateral radiographs of a 5-year-old boy with complete opacity of the right hemithorax and displacement of the heart and mediastinum to the right. Note the tracheal displacement to the right. (d) Bronchography and (e) pulmonary angiography in the same patient demonstrate complete absence of the main right pulmonary bronchus and artery, with normal left arteries and bronchial branches

View larger version (112K): [in a new window]   Figure 7e.  Lung agenesis. (a) Schematic of lung agenesis. (b) Posteroanterior and (c) lateral radiographs of a 5-year-old boy with complete opacity of the right hemithorax and displacement of the heart and mediastinum to the right. Note the tracheal displacement to the right. (d) Bronchography and (e) pulmonary angiography in the same patient demonstrate complete absence of the main right pulmonary bronchus and artery, with normal left arteries and bronchial branches

View larger version (166K): [in a new window]   Figure 8a.  Lung agenesis of the left upper lobe. (a) Posteroanterior and (b) lateral chest radiographs of a girl with opacity of the left upper lobe (white arrows) and displacement of the mediastinum to the left. Note the compensatory hyperinflation of the left lower lobe. There are various hemivertebra (black arrows) and small left ribs.

View larger version (136K): [in a new window]   Figure 8b.  Lung agenesis of the left upper lobe. (a) Posteroanterior and (b) lateral chest radiographs of a girl with opacity of the left upper lobe (white arrows) and displacement of the mediastinum to the left. Note the compensatory hyperinflation of the left lower lobe. There are various hemivertebra (black arrows) and small left ribs.

View larger version (99K): [in a new window]   Figure 9a.  Pulmonary hypoplasia. (a) Schematic illustrates pulmonary hypoplasia. (b) Anteroposterior chest radiograph of a 7-month-old infant shows opacity of the left hemithorax and small left lung (arrows) with ipsilateral displacement of the mediastinum, secondary to repaired Bochdaleck hernia.

View larger version (127K): [in a new window]   Figure 9b.  Pulmonary hypoplasia. (a) Schematic illustrates pulmonary hypoplasia. (b) Anteroposterior chest radiograph of a 7-month-old infant shows opacity of the left hemithorax and small left lung (arrows) with ipsilateral displacement of the mediastinum, secondary to repaired Bochdaleck hernia.

View larger version (154K): [in a new window]   Figure 10a.  Pulmonary hypoplasia. (a) Anteroposterior radiograph shows opacity of the right hemithorax and a shift of the mediastinal structures to the right, due to pulmonary hypoplasia secondary to right diaphragmatic agenesis. (b) Angiographic MR image of a 10-year-old boy shows a hypoplastic right pulmonary artery (arrows).

View larger version (156K): [in a new window]   Figure 10b.  Pulmonary hypoplasia. (a) Anteroposterior radiograph shows opacity of the right hemithorax and a shift of the mediastinal structures to the right, due to pulmonary hypoplasia secondary to right diaphragmatic agenesis. (b) Angiographic MR image of a 10-year-old boy shows a hypoplastic right pulmonary artery (arrows).

View larger version (81K): [in a new window]   Figure 11a.  Scimitar syndrome. (a) Schematic illustrates the characteristic findings of the scimitar syndrome. (b) Chest radiograph shows decreased aeration of the right hemithorax and displacement of the heart and mediastinum to the right. There is loss of the right heart shadow due to the right pulmonary hypoplasia and to the pulmonary vein coursing to the right cardiophrenic angle (scimitar sign) (arrows). (c) Angiographic MR image shows the anomalous vein draining into the inferior vena cava (arrows). (d) Angiographic MR image of a patient after surgery for scimitar syndrome. Note the anomalous vein draining now into the right atrium (arrow).

View larger version (156K): [in a new window]   Figure 11b.  Scimitar syndrome. (a) Schematic illustrates the characteristic findings of the scimitar syndrome. (b) Chest radiograph shows decreased aeration of the right hemithorax and displacement of the heart and mediastinum to the right. There is loss of the right heart shadow due to the right pulmonary hypoplasia and to the pulmonary vein coursing to the right cardiophrenic angle (scimitar sign) (arrows). (c) Angiographic MR image shows the anomalous vein draining into the inferior vena cava (arrows). (d) Angiographic MR image of a patient after surgery for scimitar syndrome. Note the anomalous vein draining now into the right atrium (arrow).

View larger version (116K): [in a new window]   Figure 11c.  Scimitar syndrome. (a) Schematic illustrates the characteristic findings of the scimitar syndrome. (b) Chest radiograph shows decreased aeration of the right hemithorax and displacement of the heart and mediastinum to the right. There is loss of the right heart shadow due to the right pulmonary hypoplasia and to the pulmonary vein coursing to the right cardiophrenic angle (scimitar sign) (arrows). (c) Angiographic MR image shows the anomalous vein draining into the inferior vena cava (arrows). (d) Angiographic MR image of a patient after surgery for scimitar syndrome. Note the anomalous vein draining now into the right atrium (arrow).

View larger version (147K): [in a new window]   Figure 11d.  Scimitar syndrome. (a) Schematic illustrates the characteristic findings of the scimitar syndrome. (b) Chest radiograph shows decreased aeration of the right hemithorax and displacement of the heart and mediastinum to the right. There is loss of the right heart shadow due to the right pulmonary hypoplasia and to the pulmonary vein coursing to the right cardiophrenic angle (scimitar sign) (arrows). (c) Angiographic MR image shows the anomalous vein draining into the inferior vena cava (arrows). (d) Angiographic MR image of a patient after surgery for scimitar syndrome. Note the anomalous vein draining now into the right atrium (arrow).

View larger version (159K): [in a new window]   Figure 12a.  Type I congenital cystic adenomatoid malformation. (a) Anteroposterior and (b) lateral chest radiographs of a newborn show a multicystic mass occupying the right hemithorax (note the variable size of the cysts, some of them >2 cm) (arrows).

View larger version (159K): [in a new window]   Figure 12b.  Type I congenital cystic adenomatoid malformation. (a) Anteroposterior and (b) lateral chest radiographs of a newborn show a multicystic mass occupying the right hemithorax (note the variable size of the cysts, some of them >2 cm) (arrows).

View larger version (153K): [in a new window]   Figure 13a.  Type I congenital cystic adenomatoid malformation. (a) Anteroposterior chest radiograph of a 5-year-old child shows a bubbly mass in the left upper lobe with a dominant air cyst morre than 4 cm in diameter (arrows). (b) CT scan of the same patient shows a hypoattenuating, clearly delineated cystic mass (*) in the left upper lobe.

View larger version (119K): [in a new window]   Figure 13b.  Type I congenital cystic adenomatoid malformation. (a) Anteroposterior chest radiograph of a 5-year-old child shows a bubbly mass in the left upper lobe with a dominant air cyst morre than 4 cm in diameter (arrows). (b) CT scan of the same patient shows a hypoattenuating, clearly delineated cystic mass (*) in the left upper lobe.

View larger version (166K): [in a new window]   Figure 14a.  Type II congenital cystic adenomatoid malformation. (a) Anteroposterior chest radiograph of a newborn shows a heterogeneous bubbly mass in the left lung displacing mediastinal structures to the right. (b) Coronal T1-weighted image in the same patient shows cysts (arrows) smaller than 2 cm in diameter. (c) In another newborn patient, chest CT shows a complex cystic mass in the right upper lobe, smaller than the type I mass seen in Figure 13b.

View larger version (184K): [in a new window]   Figure 14b.  Type II congenital cystic adenomatoid malformation. (a) Anteroposterior chest radiograph of a newborn shows a heterogeneous bubbly mass in the left lung displacing mediastinal structures to the right. (b) Coronal T1-weighted image in the same patient shows cysts (arrows) smaller than 2 cm in diameter. (c) In another newborn patient, chest CT shows a complex cystic mass in the right upper lobe, smaller than the type I mass seen in Figure 13b.

View larger version (104K): [in a new window]   Figure 14c.  Type II congenital cystic adenomatoid malformation. (a) Anteroposterior chest radiograph of a newborn shows a heterogeneous bubbly mass in the left lung displacing mediastinal structures to the right. (b) Coronal T1-weighted image in the same patient shows cysts (arrows) smaller than 2 cm in diameter. (c) In another newborn patient, chest CT shows a complex cystic mass in the right upper lobe, smaller than the type I mass seen in Figure 13b.

View larger version (165K): [in a new window]   Figure 15.  Type III congenital cystic adenomatoid malformation. Anteroposterior chest radiograph of a premature girl weighing 700 g shows an irregular microcystic mass affecting the left lung and displacing the mediastinum to the right. There is an associated dextrocardia.

View larger version (70K): [in a new window]   Figure 16a.  Congenital lobar emphysema. (a) Schematic illustrates congenital lobar emphysema. (b) Posteroanterior chest radiograph shows a lucent mass in the right upper lobe (arrows) that displaces mediastinal structures to the left. (c) Lateral view shows a hyperlucent retrosternal area (arrows) that corresponds to the lobar emphysema.

View larger version (163K): [in a new window]   Figure 16b.  Congenital lobar emphysema. (a) Schematic illustrates congenital lobar emphysema. (b) Posteroanterior chest radiograph shows a lucent mass in the right upper lobe (arrows) that displaces mediastinal structures to the left. (c) Lateral view shows a hyperlucent retrosternal area (arrows) that corresponds to the lobar emphysema.

View larger version (126K): [in a new window]   Figure 16c.  Congenital lobar emphysema. (a) Schematic illustrates congenital lobar emphysema. (b) Posteroanterior chest radiograph shows a lucent mass in the right upper lobe (arrows) that displaces mediastinal structures to the left. (c) Lateral view shows a hyperlucent retrosternal area (arrows) that corresponds to the lobar emphysema.

View larger version (163K): [in a new window]   Figure 17a.  Congenital lobar emphysema. (a) One-year-old boy with hyperlucent left lung that herniates to the right (arrow), with displacement of mediastinal structures to the right. (b) CT scan shows hyperinflation of the entire left upper lobe, with patent vascular structures and slight mediastinal shift to the right.

View larger version (82K): [in a new window]   Figure 17b.  Congenital lobar emphysema. (a) One-year-old boy with hyperlucent left lung that herniates to the right (arrow), with displacement of mediastinal structures to the right. (b) CT scan shows hyperinflation of the entire left upper lobe, with patent vascular structures and slight mediastinal shift to the right.

View larger version (84K): [in a new window]   Figure 18a.  Pulmonary sequestration. (a) Schematic illustrates intra- and extralobar sequestration. (b) Frontal chest radiograph shows a water-density mass (arrows) located posteriorly in the left lower lobe. (c) Aortogram of the same patient shows the feeding vessel (arrows) of the sequestration arising from the aorta.

View larger version (137K): [in a new window]   Figure 18b.  Pulmonary sequestration. (a) Schematic illustrates intra- and extralobar sequestration. (b) Frontal chest radiograph shows a water-density mass (arrows) located posteriorly in the left lower lobe. (c) Aortogram of the same patient shows the feeding vessel (arrows) of the sequestration arising from the aorta.

View larger version (177K): [in a new window]   Figure 18c.  Pulmonary sequestration. (a) Schematic illustrates intra- and extralobar sequestration. (b) Frontal chest radiograph shows a water-density mass (arrows) located posteriorly in the left lower lobe. (c) Aortogram of the same patient shows the feeding vessel (arrows) of the sequestration arising from the aorta.

View larger version (142K): [in a new window]   Figure 19a.  Pulmonary sequestration. (a) Anteroposterior chest radiograph demonstrates a mass located posteriorly in the right lower lobe (arrows). (b) CT scan of same patient shows a complex mass affecting the medial basilar segment of the right lower lobe (arrow).

View larger version (104K): [in a new window]   Figure 19b.  Pulmonary sequestration. (a) Anteroposterior chest radiograph demonstrates a mass located posteriorly in the right lower lobe (arrows). (b) CT scan of same patient shows a complex mass affecting the medial basilar segment of the right lower lobe (arrow).

View larger version (35K): [in a new window]   Figure 20.  Schematic illustrates esophageal atresia and traacheoesophageal fistula. A, Atresia without fistula; B, atresia with proximal fistula; C, atresia with distal fistula; D, atresia with both distal and proximal fistulas; E, H-shaped fistula without atresia. The plain radiographs for types A and B are similar, as is the case for types C and D. (Reproduced, with permission, from reference 59)

View larger version (109K): [in a new window]   Figure 21a.  Esophageal atresia. (a) Esophageal atresia without fistula (type A). Frontal projection shows absence of air in the gastrointestinal tract; therefore, there is no distal traacheoesophageal fistula. This image is similar to that for atresia with proximal fistula (type B). (b) Esophageal atresia with distal fistula (type C). The catheter is coiled within the upper esophageal pouch (arrows). Air is also present in the gastrointestinal tract, indicating communication between the distal esophageal segment and the respiratory tree. (c) Tracheoesophageal fistula without atresia (type E). The fistula (arrow) arises from the anterior portion of the esophagus and passes cephalad to the posterior portion of the trachea.

View larger version (155K): [in a new window]   Figure 21b.  Esophageal atresia. (a) Esophageal atresia without fistula (type A). Frontal projection shows absence of air in the gastrointestinal tract; therefore, there is no distal traacheoesophageal fistula. This image is similar to that for atresia with proximal fistula (type B). (b) Esophageal atresia with distal fistula (type C). The catheter is coiled within the upper esophageal pouch (arrows). Air is also present in the gastrointestinal tract, indicating communication between the distal esophageal segment and the respiratory tree. (c) Tracheoesophageal fistula without atresia (type E). The fistula (arrow) arises from the anterior portion of the esophagus and passes cephalad to the posterior portion of the trachea.

View larger version (87K): [in a new window]   Figure 21c.  Esophageal atresia. (a) Esophageal atresia without fistula (type A). Frontal projection shows absence of air in the gastrointestinal tract; therefore, there is no distal traacheoesophageal fistula. This image is similar to that for atresia with proximal fistula (type B). (b) Esophageal atresia with distal fistula (type C). The catheter is coiled within the upper esophageal pouch (arrows). Air is also present in the gastrointestinal tract, indicating communication between the distal esophageal segment and the respiratory tree. (c) Tracheoesophageal fistula without atresia (type E). The fistula (arrow) arises from the anterior portion of the esophagus and passes cephalad to the posterior portion of the trachea.

View larger version (78K): [in a new window]   Figure 22.  Complete tubular esophageal duplication in an infant with history of cough and choking. Note the two channels (1 and 2). The duplicated one is located posterior to the normal esophagus.

View larger version (109K): [in a new window]   Figure 23a.  Cystic esophageal duplication in a 2-year-old child with recurrent episodes of vomiting. (a) Esophagogram shows extrinsic compression on the left wall of the esophagus (arrows). (b) On a T1-weighted coronal MR image, a sharply defined low-signal-intensity mass (arrows) is seen adjacent to the left side of the esophagus. The mass showed high signal intensity on T2-weighted images.

View larger version (150K): [in a new window]   Figure 23b.  Cystic esophageal duplication in a 2-year-old child with recurrent episodes of vomiting. (a) Esophagogram shows extrinsic compression on the left wall of the esophagus (arrows). (b) On a T1-weighted coronal MR image, a sharply defined low-signal-intensity mass (arrows) is seen adjacent to the left side of the esophagus. The mass showed high signal intensity on T2-weighted images.

View larger version (176K): [in a new window]   Figure 24a.  Cystic esophageal duplication. (a) Chest radiograph shows a widening of the right superior mediastinum (arrows). (b) Contrast-enhanced CT scan demonstrates a fluid-filled thin-walled mass adjacent to the trachea and esophagus (arrows). (c) In a different patient, esophagogram shows an extrinsic compression of the right wall of the esophagus due to a mediastinal mass (arrows) corresponding to a duplication cyst.

View larger version (91K): [in a new window]   Figure 24b.  Cystic esophageal duplication. (a) Chest radiograph shows a widening of the right superior mediastinum (arrows). (b) Contrast-enhanced CT scan demonstrates a fluid-filled thin-walled mass adjacent to the trachea and esophagus (arrows). (c) In a different patient, esophagogram shows an extrinsic compression of the right wall of the esophagus due to a mediastinal mass (arrows) corresponding to a duplication cyst.

View larger version (132K): [in a new window]   Figure 24c.  Cystic esophageal duplication. (a) Chest radiograph shows a widening of the right superior mediastinum (arrows). (b) Contrast-enhanced CT scan demonstrates a fluid-filled thin-walled mass adjacent to the trachea and esophagus (arrows). (c) In a different patient, esophagogram shows an extrinsic compression of the right wall of the esophagus due to a mediastinal mass (arrows) corresponding to a duplication cyst.

View larger version (80K): [in a new window]   Figure 25a.  Aberrant right subclavian artery. (a) Anteroposterior esophagogram shows an oblique filling defect passing cephalad from left to right (pathognomonic indentation) (arrows). (b) Lateral view shows compression in the posterior wall of the esophagus (arrow).

View larger version (89K): [in a new window]   Figure 25b.  Aberrant right subclavian artery. (a) Anteroposterior esophagogram shows an oblique filling defect passing cephalad from left to right (pathognomonic indentation) (arrows). (b) Lateral view shows compression in the posterior wall of the esophagus (arrow).

View larger version (96K): [in a new window]   Figure 26a.  Aberrant left subclavian artery. (a) Anteroposterior esophagogram shows an oblique filling defect crossing the esophagus cephalad from right to left (arrowheads). (b) Lateral view shows a posterior esophagus indentation similar to that for the aberrant right subclavian artery (arrow). (c) Contrast-enhanced CT shows the aberrant left subclavian artery (arrows).

View larger version (111K): [in a new window]   Figure 26b.  Aberrant left subclavian artery. (a) Anteroposterior esophagogram shows an oblique filling defect crossing the esophagus cephalad from right to left (arrowheads). (b) Lateral view shows a posterior esophagus indentation similar to that for the aberrant right subclavian artery (arrow). (c) Contrast-enhanced CT shows the aberrant left subclavian artery (arrows).

View larger version (117K): [in a new window]   Figure 26c.  Aberrant left subclavian artery. (a) Anteroposterior esophagogram shows an oblique filling defect crossing the esophagus cephalad from right to left (arrowheads). (b) Lateral view shows a posterior esophagus indentation similar to that for the aberrant right subclavian artery (arrow). (c) Contrast-enhanced CT shows the aberrant left subclavian artery (arrows).

View larger version (76K): [in a new window]   Figure 27a.  Double aortic arch. (a) Barium esophagogram shows bilateral extrinsic compressions on the esophagus (arrows), producing a reverse S-shaped appearance. (b) Three-dimensional MR angiogram shows a vascular ring that corresponds to a double aortic arch.

View larger version (124K): [in a new window]   Figure 27b.  Double aortic arch. (a) Barium esophagogram shows bilateral extrinsic compressions on the esophagus (arrows), producing a reverse S-shaped appearance. (b) Three-dimensional MR angiogram shows a vascular ring that corresponds to a double aortic arch.

View larger version (94K): [in a new window]   Figure 28a.  Right aortic arch. (a) Esophagogram shows a right-sided aortic arch (arrowheads) compressing the right lateral wall of the esophagus. (b) MR angiogram in the same patient shows an associated Kommerell diverticulum (arrow) at the base of the left subclavian artery.

View larger version (120K): [in a new window]   Figure 28b.  Right aortic arch. (a) Esophagogram shows a right-sided aortic arch (arrowheads) compressing the right lateral wall of the esophagus. (b) MR angiogram in the same patient shows an associated Kommerell diverticulum (arrow) at the base of the left subclavian artery.