Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 10 4 2026 04 18 185 190 Mohammad Ghanipoor Student Research Committee, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. Ebrahim Evazi Student Research Committee, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. Ayoub Basham Student Research Committee, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran Ali Hadavand Khani Department of Surgery, Shahid Mohammadi Hospital, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. Seyyed Mohammad Hashemi Student Research Committee, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. Seyed Hamid Moosavy Department of Gastroenterology, Shahid Mohammadi Hospital, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. 2025 11 23 2025 12 20 Esophageal duplication cysts (EDCs) are rare congenital foregut anomalies often presenting with nonspecific gastrointestinal (GI) symptoms in childhood. Diagnosis requires a high index of suspicion and comprehensive work-up. We report a 56-yearold male with type 2 diabetes mellitus and benign prostatic hyperplasia. He presented with a one-month history of intermittent, burning epigastric pain exacerbated by eating and accompanied by nausea. Physical examination revealed mild epigastric tenderness. Upper GI endoscopy showed a bulging lesion in the lower esophagus, a large cardia polyp, a small gastric body polyp, and antral erythema. Endoscopic ultrasound (EUS) identified a well-defined, homogeneous, round lesion (33 × 20 mm) Esophageal duplication cysts (EDCs) are rare congenital foregut anomalies often presenting with nonspecific gastrointestinal (GI) symptoms in childhood. Diagnosis requires a high index of suspicion and comprehensive work-up. We report a 56-yearold male with type 2 diabetes mellitus and benign prostatic hyperplasia. He presented with a one-month history of intermittent, burning epigastric pain exacerbated by eating and accompanied by nausea. Physical examination revealed mild epigastric tenderness. Upper GI endoscopy showed a bulging lesion in the lower esophagus, a large cardia polyp, a small gastric body polyp, and antral erythema. Endoscopic ultrasound (EUS) identified a well-defined, homogeneous, round lesion (33 × 20 mm) demonstrating acoustic enhancement in the lower esophagus. Contrast-enhanced abdominopelvic computed tomography (CT) revealed an intraluminal, non-enhancing lesion (25 × 26 mm) at the lower esophageal sphincter (LES), suggestive of a duplication cyst. Thoracic imaging showed no abnormalities. Due to persistent symptoms, the patient underwent successful video-assisted thoracoscopic surgery without complications; no recurrences occurred during follow-up. EDCs should be considered in the differential diagnosis of submucosal or intraluminal esophageal lesions, even in adults despite their rarity. EUS yields high accuracy in characterizing these lesions. Thoraco-abdominal CT scans delineate relationships to surrounding structures. For symptomatic lesions, video-assisted thoracoscopic surgery demonstrates a successful outcome with low complication rates. https://crcp.tums.ac.ir/index.php/crcp/article/view/1146 https://crcp.tums.ac.ir/index.php/crcp/article/download/1146/743