Esophageal intramural pseudodiverticulosis is an uncommon condition in which there are numerous small outpouchings within the esophageal wall.
It is a rare condition, found in <1% of oesophagrams. It may occur at any age, but is more common between 50 and 70 years. There is a slight male predominance 2.
- esophageal strictures: present in 90% of patients 1
- gastroesophageal reflux
- esophageal candidiasis
- chronic esophagitis
- esophageal carcinoma 2
Intramural pseudodiverticula represent dilated excretory ducts of the deep esophageal 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 esophageal wall, as the channel to the lumen is imperceptible
- viewed en face, may appear as ulcers 3
- intramural tracking may sometimes be seen bridging two or more pseudodiverticula 2
Treatment and prognosis
The treatment of esophageal pseudodiverticulosis is dependent on symptoms displayed and accompanying conditions 5. Around 10% of patients do no require treatment 6. The use of proton pump inhibitors can help relieve symptoms of esophagitis. If esophageal strictures are present, the use of endoscopic dilatation helps improve treatment response 5.
Pseudodiverticular rupture with resultant mediastinitis has been reported but is very rare 4.
- 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
- 5. Brühlmann WF, Zollikofer CL, Maranta E, Hefti ML, Bivetti J, Giger M, Wellauer J, Blum AL. Intramural pseudodiverticulosis of the esophagus: report of seven cases and literature review. (1981) Gastrointestinal radiology. 6 (3): 199-208. Pubmed
- 6. Stephens WP, Mossman A, Ratcliffe JF, Gould DA, Oleesky S. Intramural pseudodiverticulosis--an unusual cause of benign oesophageal stricture. (1986) Postgraduate medical journal. 62 (725): 201-4. Pubmed
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