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A lucency is seen, projected anterior to the C6/C7 intervertebral disc.
Upon swallowing, the lucency corresponds to a large outpouching of the lateral esophageal wall, with its neck arising from just inferior to the C6 vertebral body, and its most inferior extent extending to the T1 vertebral body.
The outpouching retains contrast after passage of contrast. It is smooth walled.
Zenker diverticulum is an outpouching of mucosa at Killian's dehiscence, between the two parts of the inferior constrictor. Patients often present with dysphagia and halitosis, due to bacterial breakdown of trapped food within the pouch.
There is an increased incidence of squamous cell carcinoma associated with Zenker diverticula.