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Epiphrenic diverticulum

Epiphrenic diverticula are pulsion diverticula of the distal oesophagus arising just above the lower esophageal sphincter (LES), more frequently on the right side.

They are less frequent than traction mid oesophageal diverticula, but may have more clinical relevance.  

Clinical presentation

Epiphrenic diverticula may present with symptoms of dysphagia, and regurgitation. When large they can cause distal oesophageal compression.

Associations

They are associated with:

Pathophysiology

These are considered to be pulsion type diverticula, thought to arise due to increased intraluminal pressure - and hence the strong association with oesophageal dysmotility.

The diverticulum forms as the submucosa and mucosa herniate focally through the muscularis propria.  Since the diverticular wall thus lacks the muscular layer, it is classified as a false diverticulum.

Radiographic features

Fluoroscopy - Barium swallow

Best imaging method is a contrast oesophagogram, including prone oblique views of the distal oesophagus. One should look for evidence of oesophageal motility disorders and hiatus hernia.  

Plain film

On chest x ray, they may appear as a retrocardiac soft tissue mass with or without an air fluid level, mimicing a hiatus hernia.

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