Zenker's diverticulum

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Zenker's diverticulum
Source:Radiopaedia[1]

ICD-10 K22.5
ICD-9 530.6
DiseasesDB 31174
MeSH D016672

Zenker's diverticulum Microchapters

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Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Zenker's diverticulum from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: Hypopharyngeal diverticulum, pharyngoesophageal diverticulum, pharyngeal pouch.

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Zenker's diverticulum from other Diseases

Disease Signs & Symptoms Findings on barium swallow Endoscopy Imaging test
Reflux esophagitis Dysphagia (from peptic stricture)

Heartburn

Hoarseness

  • Poor clearance
  • Free reflux of barium
  • peptic stricture (advanced cases)
A hiatus hernia may be present below the stricture

Lower esophageal pH studies will demonstrate pathologic gastroesophageal reflux

Esophageal carcinoma Dysphagia (initially for solids, liquids develops with advanced disease.)

Weight loss

Lymphadenopathy

Appetite changes

Cachexia

  • irregular stricture
  • pre-stricture dilatation
  • Most accurate test for diagnosis
  • esophageal obstruction
  • staging of disease
Biopsy: for definite diagnosis and tumor histology
Systemic sclerosis Dysphagia

Muscle and joint pain

Raynaud's phenomenon

skin changes (e.g., rash, skin swelling or thickening).

  • Dysmotility
  • Patulous esophagus
Mucosal damage

Peptic stricture (advanced cases)

Serology for

Antinuclear antibodies

Rheumatoid factor

creatine kinase

ESR

Esophageal spasm Chest pain (more prominent)

Dysphagia (intermittent)

  • Corkscrew or

rosary bead esophagus

  • nonperistaltic contractions
Inconclusive Manometry: high-amplitude esophageal contractions
Pseudoachalasia Dysphagia

Weight loss

Lymphadenopathy

Appetite changes

Cachexia

Older patients

Underlying malignancy that mimics idiopathic achalasia.

Patients tend to be older, duration of symptoms shorter, and weight loss greater and more rapid.

  • More marked mucosal irregularity
  • Temporary patency of LES
  • Most accurate test for diagnosis
  • esophageal obstruction
  • staging of disease
Gastroscopic biopsy of gastroesophageal junction and cardia may demonstrate malignancy.

Findings at endoscopy, barium swallow, and manometry may be indistinguishable from achalasia.

Chagas disease Dysphagia

myocarditis

Blepharitis

Toxic megacolon

  • oesophageal dilatation
  • stasis of barium
  •  dilated esophagus
  • thickened LES (muscular ring)
Giemsa stain: Trypanosoma cruzi.

PCR for trypanosome subtype

Pharyngitis Dysphagia

Fever

Throat pain

Normal Inconclusive erythema, edema and/or exudates of the pharynx; tonsillar hypertrophy may cause severe narrowing of the pharynx; lymphadenopathy of the neck is often present
Esophageal candidiasis Dysphagia

Immunocompromised

History of corticosteroid

  • shaggy" appearance (plaques)
  • irregular contours in the lower third
  • ulceration 
  • plaques and pseudomembranes
  • tiny nodules, polypoid folds (advanced cases)
creamy white or yellowish plaques (thrush) in oropharynx or hypopharynx; may be normal exam
Stroke progressive Dysphagia;

dysarthria;

limb weakness

Fatigue

  • pooling of contrast in the pharynx
  • aspiration of the barium contrast into the airway.
  • reduced opening of upper esophageal sphincter
  • reduced larynx elevation
paraplegia, aphasia, dysarthria, vertigo, staggering, diplopia, deafness

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | X Ray | CT | MRI | Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1

Template:Gastroenterology de:Zenker-Divertikel it:Diverticolo di Zenker


Template:WikiDoc Sources

  1. "Zenker diverticulum | Radiology Case | Radiopaedia.org".