Pulsion esophageal diverticulum
One year of dysphagia.
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Esophagogram shows the presence of rounded contour outpouchings in the mid esophagus in relation with pulsion diverticula. Both diverticulae showed rounded contour and wide necks. Both remain filled after most of the barium has emptied from the esophagus by peristalsis.
Proximally and distally to the diverticulum there are areas with evidence of esophageal dysmotility.
Esophageal diverticula is an outpouching projecting from the esophagus. Diverticula may be classified by their location or by their mechanism of formation.
- pharyngoesophageal junction (upper esophagus), i.e. Zenker's diverticulum.
- distal esophagus just above the gastroesophageal junction, i.e. epyphrenic diverticulum.
By mechanism of formation:
- pulsion diverticulum develops as a result of increased intraluminal esophageal pressure from underlying esophageal dysmotility. Frequently multiple.
traction diverticulum develops because of fibrosis in adjacent peri-esophageal tissues.
Usually, they are incidental findings in asymptomatic patients.
Oesohagogram: barium filled outpouchings projecting from the esophagus, best seen in profile.
Pulsion diverticula: Most common, usually located in the middle or distal third of the esophagus, often associated with motility disorder. They appear as outpouching with rounded contour and a wide neck. "False diverticulum".
Traction diverticula: usually have a triangular configuration as a result of scarring and retraction (surgery, radiation, or granulomatous disease affecting the adyacent mediastinum). They tend to occur as solitary outpouchings containing all of the esophageal wall layers. They tend to empty when the esophagus collapses (muscular layer of the esophageal wall). "True diverticulum"
Case courtesy: Dr Jose R Zuniga.
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- Levine MS, Rubesin SE. Diseases of the esophagus: diagnosis with esophagography. Radiology. 2005;237 (2): 414-27. Radiology (full text) - doi:10.1148/radiol.2372050199 - Pubmed citation
- Achkar E. Esophageal diverticula. Gastroenterol Hepatol (N Y). 2011;4 (10): 691-3. Free text at pubmed - Pubmed citation