Clinical Presentation

A 56-year-old woman presents with dysphagia.

Further Work-up

(A) Lateral radiograph of the neck shows widening of the retrotracheal soft-tissue space and a small focus of gas (arrow). (B) Lateral radiograph during a barium swallow shows retention of barium in a saccular structure (arrow) within the retrotracheal soft tissues. This structure communicates with the pharyngoesophageal junction.

Differential Diagnosis

• Zenker diverticulum (ZD): ZD is the most likely diagnosis, given the absence of clinical information suggesting infection or foreign body. A chronic history of bad breath and the periodic regurgitation of foul-smelling food would further support this diagnosis. The barium study findings are pathognomonic for ZD. This differential list is for the radiographic findings.