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.

Radiological findings

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.
Killian-Jamieson diverticula occur in a triangular area of weakness in the cervical esophagus below the cricopharyngeus muscle in contrast to Zenker's diverticula. Most patients with Killian-Jamieson diverticula are asymptomatic, but some may present with dysphagia or regurgitation of undigested food. On lateral projections, the sac is anterior to the cervical esophagus below the level of the cricopharyngeus.

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.