Presentation
Two days acutely worsening dysphagia, on a few months of deteriorating swallow. Background NF1. ? infection ? malignancy
Patient Data
Lateral to the cervical esophagus there is a 55 mm pouch filled with gas and debris (presumed retained foodstuff) extending from C4-6 level on the left side. The content of this pouch indents the left side of the esophagus, with no clear channel from the lumen (a water soluble swallow study may be useful here). The superior margin of this elevates the cricoid cartilage and glottic structures (further assessment of the glottis is limited due to swallowing artefact). More inferiorly, this is deep to the left thyroid lobe, elevating the carotid space vessels. There is no definite mass in the esophagus immediately inferior to this but CT is limited in this regard. There is no significant surrounding fat stranding or inflammatory change.
A large lateral Killian-Jamieson esophageal diverticulum is confirmed on water contrast swallow study, with some delayed secondary transit.
Case Discussion
An example of the less common lateral esophageal diverticulum - the Killian-Jamieson diverticulum. This is in comparison with the posterior Zenker diverticulum (which occurs at the Killian dehiscence - out to confuse those learning head and neck and upper GI anatomy!).
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