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Zenker's Diverticula Mid-Esophageal Diverticula Epiphrenic Diverticula

Afiesimama BOA - MedPix (2007)

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Zenker's Diverticula Mid-Esophageal Diverticula Epiphrenic Diverticula

History: Three separate patients who presented with similar complaints. Patient A- Presented with fever, paroxysmal cough, and vague throat discomfort. Film A1-PA chest film Film A2-Barium swallow, three views. Patient B- Presented with occasional mild dysphagia. Film B1-Barium swallow, lateral view. Patient C- Complains of dysphagia and regurgitation of food at night while sleeping. Film C1-PA chest film. Film C2-Barium swallow. Film C3-Barium swallow, film taken during valsalva.

Findings: A1- Right middle lobe infiltrate with fluid in the minor fissure and possible involvement of the lower segment of the right upper lobe. Right pleural effusion. A2- Saccular outpouching of the esophageal lumen arising on the posterior wall at the level of the pharyngoesophageal junction and displacing the esophagus anteriorly. Diagnosis-A very large Zenker's diverticula from which the patient has aspirated and developed an aspiration pneumonia. As the diverticula enlarges it extends downward and posteriorly, displacing the cervical esophagus anteriorly and compressing the lumen. Due to its posterior location a Zenker's is best seen in lateral or oblique views B1- An overexposed film showing a fusiform diverticula of the esophageal lumen located in the mid-esophagus. Diagnosis-A mid-esophageal diverticuli. Such diverticula can be funnel, cone, tent or fusiform in shape. They are best visualized in the LAO position and are often found in association with calcified mediastinal nodes from healed granulomatous disease (see discussion). C1- Large cystic structure overlying right hemidiaphragm which contains an air fluid level. There is also an air fluid level in the upper esophagus at the level of the clavicles. C2- Large diverticula off the lower esophagus just above the gastroesophageal junction. The diverticula has a short broad neck. C3- Upon valsalva the diverticula does not appear to change, and there is no gastric mucosal pattern seen in the diverticula. This, therefore, does not likely represent a hiatal hernia. Note the NG tube in place. Diagnosis- The proximity to the diaphragm and the characteristic short broad neck of this diverticula make it an epiphrenic diverticula. The diverticula should have a smooth contour as irregularity may suggest infection or malignancy. Small epiphrenic diverticula may resemble esophageal ulcers but will usually have abnormal mucosal patterns in the adjacent esophagus.

Ddx: Zenker's Diverticula Mid-Esophageal Diverticula Epiphrenic Diverticula

No MeSH data available.


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Zenker's Diverticula Mid-Esophageal Diverticula Epiphrenic Diverticula

Afiesimama BOA - MedPix (2007)

See case description for C2
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX1685&req=5

MPX1685_synpic38153: See case description for C2

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Zenker's Diverticula Mid-Esophageal Diverticula Epiphrenic Diverticula

History: Three separate patients who presented with similar complaints. Patient A- Presented with fever, paroxysmal cough, and vague throat discomfort. Film A1-PA chest film Film A2-Barium swallow, three views. Patient B- Presented with occasional mild dysphagia. Film B1-Barium swallow, lateral view. Patient C- Complains of dysphagia and regurgitation of food at night while sleeping. Film C1-PA chest film. Film C2-Barium swallow. Film C3-Barium swallow, film taken during valsalva.

Findings: A1- Right middle lobe infiltrate with fluid in the minor fissure and possible involvement of the lower segment of the right upper lobe. Right pleural effusion. A2- Saccular outpouching of the esophageal lumen arising on the posterior wall at the level of the pharyngoesophageal junction and displacing the esophagus anteriorly. Diagnosis-A very large Zenker's diverticula from which the patient has aspirated and developed an aspiration pneumonia. As the diverticula enlarges it extends downward and posteriorly, displacing the cervical esophagus anteriorly and compressing the lumen. Due to its posterior location a Zenker's is best seen in lateral or oblique views B1- An overexposed film showing a fusiform diverticula of the esophageal lumen located in the mid-esophagus. Diagnosis-A mid-esophageal diverticuli. Such diverticula can be funnel, cone, tent or fusiform in shape. They are best visualized in the LAO position and are often found in association with calcified mediastinal nodes from healed granulomatous disease (see discussion). C1- Large cystic structure overlying right hemidiaphragm which contains an air fluid level. There is also an air fluid level in the upper esophagus at the level of the clavicles. C2- Large diverticula off the lower esophagus just above the gastroesophageal junction. The diverticula has a short broad neck. C3- Upon valsalva the diverticula does not appear to change, and there is no gastric mucosal pattern seen in the diverticula. This, therefore, does not likely represent a hiatal hernia. Note the NG tube in place. Diagnosis- The proximity to the diaphragm and the characteristic short broad neck of this diverticula make it an epiphrenic diverticula. The diverticula should have a smooth contour as irregularity may suggest infection or malignancy. Small epiphrenic diverticula may resemble esophageal ulcers but will usually have abnormal mucosal patterns in the adjacent esophagus.

Ddx: Zenker's Diverticula Mid-Esophageal Diverticula Epiphrenic Diverticula

No MeSH data available.