GI Radiology > Esophagus > Structural Abnormalities
Structural Abnormalities of the Esophagus
Diverticula |
Clinical Esophageal diverticula can be classified based on their location (i.e. cervical, midesophageal, epiphrenic, intramural, or intraluminal) or by mechanism of formation (i.e. traction versus pulsion). The diverticular walls may contain all esophageal layers (traction) or may only contain mucosa and submucosa herniating through the muscular layer (pulsion). Most often, esophageal diverticula are found incidentally and asymptomatic. However, if the diverticula is large enough it may fill with food or fluids and compress the true lumen of the esophagus causing dysphagia. Zenker's diverticula or posterior hypopharyngeal diverticula are of the pulsion type. They are acquired lesions where mucosa herniates through an area of weakness around the cricopharyngeus muscle. Premature contraction or muscle incoordination of the cricopharyngeus muscle produces increased intraluminal pressure. This phenomenon is also known as Killian's dehiscence. Zenker's diverticula are often found in older patients who present with dysphagia, regurgitation of undigested food, choking, hoarseness, halitosis or even a neck mass.
Zenker's diverticula
appear as a posterior bulge of the distal pharyngeal wall above the cricopharyngeus
muscle. They are best visualized during a barium swallow in the lateral
projection. Image
"A" depicts the frontal view of a large barium-filled sac (Z)
below the level of the hypopharynx. Image "B" is a lateral view
depicting a large Zenker's diverticula (Z) in the posterior cervical esophagus. |