A 42-year-old man with complaints of dry cough and breathlessness for 15 days was referred to the Radiology Department for Computed Tomography of the thorax. His chest X-ray showed cavitation and fibrosis with patchy consolidation in the right upper zone. Patient was a diagnosed case of sputum-positive pulmonary tuberculosis and had received the complete course of antitubercular treatment 2 years earlier. On present Computed Tomography of the thorax (axial images), there were multiple thick-walled cavitary lesions in the posterior segment of right upper lobe with multiple parenchymal nodular opacities indicative of endobronchial spread of infection [Figure 1]. In addition to these findings, there was an air-filled tubular structure alongside the esophagus on the left side, beginning at the level of the T2 vertebra and communicating with the normal esophagus at the level of carina [Figure 2]. We considered a provisional diagnosis of pulsion diverticula or possibly proximal esophageal duplication as an incidental finding along with the findings of sequelae of post-primary pulmonary tuberculosis.
Barium swallow study [Figure 3] was done to rule out diverticulum. On barium study, a contrast-filled tubular structure was seen alongside the normal esophagus on the left side extending from the T2 to the T4 vertebral level and communicating with the esophagus both superiorly and inferiorly. Fluoroscopically, swallowing mechanism was normal with normal mucosa and presence of peristalsis in the duplicated segment. There was no evidence of any aspiration or gastroesophageal reflux. Gastroesophageal junction was normal. With these definitive findings, diagnosis of incomplete communicating tubular duplication of upper esophagus was considered.
Plain CT upper thorax lung window shows multiple cavitary lesions in the right upper lobe.