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Special Feature
May 2002

Image of the Month

Arch Surg. 2002;137(5):619. doi:
Answer: Zenker Diverticulum

Figure 1. Transverse view of cervical ultrasound showing a comet-tail artifact. T indicates thyroid gland; CA, carotid artery.

Figure 2. Lateral view of barium swallow showing the Zenker diverticulum.

The pharyngoesophageal or Zenker diverticulum is the most common diverticulum of the esophagus and is typically located posteriorly on the left side of the neck. It is a pulsion or false diverticulum resulting from incoordination of cricopharyngeal function. Patients frequently present with dysphasia, a gurgling sound when swallowing liquids, or regurgitation of food. A large diverticulum may be diagnosed by a plain neck x-ray film showing an air-fluid level, but more frequently the diagnosis is made by a barium swallow study. The use of ultrasound for making this diagnosis has been reported in patients with symptomatic large diverticula.1,2 Treatment usually requires cervical esophagomyotomy and diverticulectomy.

In our patient, the lesion was easily identified on ultrasound, as multiple hyperechoic spots were noted when the patient swallowed. The movement of the hyperechoic spots was consistent with the air moving back into the esophagus, which made the diagnosis of Zenker diverticulum. The diagnosis was confirmed by a subsequent barium swallow study (Figure 2).

Corresponding author: Junji Machi, MD, PhD, 405 N Kuakini St, Suite 601, Honolulu, HI 96817 (e-mail: j.machi@surgedinc.org).

DeFriend  DEDubbins  PA Sonographic demonstration of a pharyngoesophageal diverticulum. J Clin Ultrasound. 2000;28485- 487Article
Kumar  KAggarwel  SPhem  DH Pharyngoesophageal (Zenker's) diverticulum mimicking thyroid nodule on ultrasonography. J Ultrasound Med. 1994;13319- 322