Intramural Pseudodiverticulosis

Michael P. Federle, MD, FACR

Key Facts

Terminology

Rare benign disorder characterized by esophageal diverticulosis-like outpouchings
Caused by dilation of excretory ducts of deep mucous glands
Associated with esophagitis stricture ± motility disorders

Imaging

Barium esophagram more sensitive than endoscopy
Innumerable, tiny, barium-filled outpouchings
- In longitudinal rows parallel to long axis of esophagus
- Flask-shaped, 1-4 mm
- Incomplete filling may erroneously suggest lack of communication with esophageal lumen
Intramural tracks: Bridging between adjacent pseudodiverticula
- More likely to occur with diffuse form of intramural pseudodiverticulosis
Stricture: Pseudodiverticula often extend above and below level of stricture
- Stricture could be benign or malignant

Top Differential Diagnoses

Esophagitis
- Multiple discrete ulcers associated with various types of esophagitis
- True ulcers communicate directly with lumen
- Ulcers, strictures, and pseudodiverticula can occur together

Diagnostic Checklist

Periodic surveillance of patients with IPD for esophageal carcinoma

(Left) Endoscopic photograph shows the opening of innumerable pseudodiverticula, many arranged in orderly, longitudinal rows. (Right) Spot film from a barium esophagram demonstrates the classic findings of innumerable tiny collections of barium within the esophageal wall. Decreased primary peristalsis and tertiary contractions were also evident on fluoroscopy.

(Left) Two views from a double contrast esophagram reveal innumerable tiny, flask-shaped outpouchings along the entire length of the esophagus, findings pathognomonic of pseudodiverticulosis. (Right) Film from a barium esophagram demonstrates a small hiatal hernia