Zenker Diverticulum



Zenker Diverticulum


Michael P. Federle, MD, FACR





Key Facts


Terminology



  • Mucosal herniation through area of anatomic weakness in region of cricopharyngeal muscle


Imaging



  • Barium-filled sac posterior to cervical esophagus



    • Opening into pouch just above cricopharyngeus muscle (C5-6 level)


    • Prominent or thickened cricopharyngeal muscle


    • Luminal narrowing at pharyngoesophageal junction due to extrinsic compression


    • Large diverticulum may protrude laterally to left or compress cervical esophagus


  • Almost all patients have associated esophageal dysmotility, often with hiatal hernia and GERD


Top Differential Diagnoses



  • Killian-Jamieson diverticulum



    • Opening below cricopharyngeus muscle


    • Protrude laterally


  • Esophageal webs


  • Epidermolysis and pemphigoid


Clinical Issues



  • Upper esophageal dysphagia



    • Regurgitation and aspiration of undigested food


  • Complications



    • Risk of perforation during endoscopy or placement of nasogastric tube


    • Aspiration pneumonia (in 30% of cases)


    • Risk of carcinoma (seen in 0.3% of cases)


  • Surgical diverticulectomy or endoscopic repair


Diagnostic Checklist



  • Following repair of Zenker diverticulum, residual outpouching will still be seen in most cases






(Left) Graphic shows a pouchlike herniation through the Killian dehiscence in the cricopharyngeal muscle. (Right) Lateral view of a barium swallow shows a large pouch image arising from the posterior pharyngoesophageal junction.






(Left) A film from a barium esophagram shows a large diverticulum image arising from the pharyngoesophageal junction and extending into the mediastinum. The esophagus is displaced, and its lumen is narrowed by the diverticulum. Note the barium aspirated into the trachea image. (Right) Axial NECT in the same patient shows the diverticulum image filled with debris, fluid, and gas. Large diverticula often compress the lumen of the esophagus and extend to 1 side of the midline due to mass effect.



TERMINOLOGY


Synonyms



  • Pharyngoesophageal diverticulum or posterior hypopharyngeal diverticulum/outpouching


Definitions



  • Mucosal herniation through area of anatomic weakness in region of cricopharyngeal muscle


IMAGING


General Features



  • Best diagnostic clue



    • Barium-filled sac posterior to cervical esophagus


  • Location



    • Killian dehiscence (triangular anatomical area of weakness)



      • Midline posterior wall of pharyngoesophageal segment just above cricopharyngeus muscle (C5-6 level)


      • Between oblique and horizontal fibers of cricopharyngeal muscle (most common site) or between thyro-/cricopharyngeal muscles


      • This area of weakness occurs in 1/3 of patients


  • Size



    • Average maximal dimension: 2.5 cm


    • Range: 0.5-8 cm


  • Morphology



    • Posterior hypopharyngeal saccular outpouching with neck opening above cricopharyngeus muscle


  • Zenker diverticulum is a false diverticulum



    • Presence of mucosa and submucosa


    • Lack of muscle


  • Almost all patients have associated esophageal dysmotility, often with hiatal hernia and gastroesophageal reflux disease (GERD)


  • On barium studies: Any irregularity of contour of Zenker diverticulum suggests either inflammatory or neoplastic complication


Radiographic Findings

Tags:
Jun 8, 2016 | Posted by in GENERAL RADIOLOGY | Comments Off on Zenker Diverticulum

Full access? Get Clinical Tree
Get Clinical Tree app for offline access