Fact-sheet: Pharyngoesophageal - Zenker diverticulum
Updated on 09/30/2019 at 6:25 PM
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Definition
Zenker diverticulum: Diverticulum arising from the posterior wall of the hypopharynx between the oblique and transverse heads of the cricopharyngeus muscle.
Risk factors: esophageal achalasia, GERD, hiatal hernia
Complications: aspiration bronchiolitis, superinfection, ulceration, fistula formation.
Neoplastic transformation in 0.3% of cases.
Clinical features
Compressible cervical mass
Upper esophageal dysphagia
Regurgitation, aspiration episodes
Noisy swallowing
Halitosis
Radiography
Plain radiograph: air-fluid level in the upper retrotracheal space
Barium esophagram (gold standard): posterior saccular pouch filling with barium, whose neck opens above the cricopharyngeus muscle (C5-C6)
+/- nasopharyngeal regurgitation after swallowing
Classification
Van Overbeek classification:
Grade I: Maximum diameter less than the height of one thoracic vertebra: small diverticulum less than 2 cm.
Grade II: Maximum diameter equal to the height of the vertebral bodies of 1 to 3 thoracic vertebrae: medium diverticulum between 2 and 4 cm
Grade III: Maximum diameter greater than the height of the vertebral body of 3 thoracic vertebrae: diverticulum larger than 4 cm
Differential diagnosis
Killian-Jamieson diverticulum: Pulsion-type pseudodiverticulum. Protrusion of a portion of the esophagus (transient or permanent) through the Killian-Jamieson space (anterolateral) below the cricopharyngeus muscle. Rarer and smaller (3-20 mm)
Laimer diverticulum differs from Zenker diverticulum in that it arises below the cricopharyngeus muscle. Endoscopic correlation is required to confirm this rare diagnosis.