Infected and fistulized Killian-Jamieson diverticulum
Chronic dysphagia becomes painful with halitosis the last two weeks
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The enhanced CT with oral opacification demonstrate a left-sided esophageal outpouching anterolateral to esophagus and below the level of the cricopharyngeal muscle, containing food debris, and air-bubbles with thick enhancing wall. The adjacent left thyroid lobe shows a fluid collection with air-bubbles. The communication with the pharyngo-esophageal junction is well-visualized on the enlarged axial images.
CT features are consistent with an infected Killian-Jamieson diverticulum fistulized towards the left thyroid lobe, which was confirmed at surgery.
Killian-Jamieson diverticulum is rare esophageal outpouching arising from the lateral wall of the proximal cervical esophagus; inferior to the cricopharyngeus muscle 1. It represents an outpouching of mucosa through a muscular defect, The most common symptoms are dysphagia, cough and epigastric pain 1.
It is distinct from the more commonly known Zenker diverticulum which is seen in the posterior wall of the pharynx 1. Barium esophagography and CT scan are useful to confirm the diagnosis and differentiate between both diverticula 1. The treatment is surgical (transcutaneous diverticulectomy +/- oesophagomyotomy) 1.
Additional contributor ZE. Boudiaf; MD CHU Constantine; Algeria.
- 1. Boisvert RD, Bethune DC, Acton D, Klassen DR. Bilateral Killian-Jamieson diverticula: a case report and literature review. (2010) Canadian journal of gastroenterology = Journal canadien de gastroenterologie. 24 (3): 173-4. Pubmed