Oesophageal intramural pseudodiverticulosis is an uncommon condition in which there are numerous small outpouchings within the oesophageal wall.
It is a rare condition, found in <1% of oesophagrams. It may occur at any age, but is more common at 50-70 years old. There is a slight male predominance 2.
- oesophageal strictures: present in 90% of patients 1
- gastroesophageal reflux
- oesophageal candidiasis
- chronic oesophagitis
- oesophageal carcinoma 2
Intramural pseudodiverticula represent dilated excretory ducts of the deep oesophageal mucosal glands 1.
Barium swallow examination is the study of choice, as the ductal orifices may be too small to be seen on endoscopy. Pseudodiverticula are better seen with a single contrast examination than with a double contrast, thin barium examination 1,2.
- numerous, tiny (1-4 mm), flask-shaped outpouchings
- may be diffusely distributed or clustered.
- clustering may occur next to peptic strictures
- viewed in profile, often appear “floating” next to the oesophageal wall, as the channel to the lumen is imperceptible
- viewed en face, may look like ulcers 3
- intramural tracking may sometimes be seen bridging two or more pseudodiverticula 2
Treatment and prognosis
Pseudodiverticular rupture with mediastinitis has been reported but is very rare 4.
- oesophageal dysmotility
- oesophageal tumours
- benign oesophageal neoplasms
- malignant oesophageal neoplasms
- gastro-oesophageal reflux disease
- oesophageal stricture
- 1. Levine MS, Moolten DN, Herlinger H et-al. Esophageal intramural pseudodiverticulosis: a reevaluation. AJR Am J Roentgenol. 1986;147 (6): 1165-70. AJR Am J Roentgenol (abstract) - Pubmed citation
- 2. Canon CL, Levine MS, Cherukuri R et-al. Intramural tracking: a feature of esophageal intramural pseudodiverticulosis. AJR Am J Roentgenol. 2000;175 (2): 371-4. AJR Am J Roentgenol (full text) - Pubmed citation
- 3. Weissleder R, Wittenberg J, Harisinghani MG. Primer of diagnostic imaging. Mosby Inc. (2003) ISBN:0323023282. Read it at Google Books - Find it at Amazon
- 4. Kim S, Choi CD, Groskin SA. Esophageal intramural pseudodiverticulitis. Radiology. 1989;173 (2): 418. Radiology (citation) - Pubmed citation