A 50-year-old man, who was previously healthy, presented with symptoms that included progressive intermittent but severe dysphagia, halitosis, paroxysms of coughing and regurgitation of food and liquids. He also had an unintentional weight loss of 20 kg. These symptoms developed during a 15-month period. He had no history of tobacco or alcohol use. Results of the physical examination done were found to be normal. A radiographic image was obtained.




What Is the diagnosis?

ANSWER

Giant Zenker's diverticulum

Xray showed a large fluid level from the midline at the upper mediastinum above the aortic arch and there was no evidence of a lower mediastinum widening.After swallowing barium, there appeared a large esophageal outpouching arising from the midline of the posterior wall of the pharyngoesophageal junction. The radiological diagnosis suggested that the patient had a pharyngoesophageal diverticulum (Zenker´s diverticulum).

Zenker's diverticulum is a pseudodiverticulum consisting of mucosa and submucosa that arise from the posterior portion of the inferior pharyngeal constrictor muscle. The Zenker diverticulum occurs at an area of potential weakness in the inferior pharyngeal constrictor muscle referred to as the Killian dehiscence.
The most common presenting feature is upper esophageal dysphagia, which occurs in as many as 98% of patients. Other common symptoms include halitosis, regurgitation of undigested food, noisy swallowing, and aspiration. Some patients also report excessive salivation and the sensation of a mass within the throat. Weight loss and recurrent pulmonary infections occur in approximately one-third of the patients.
hysical examination findings are rare, although some extremely large diverticula are occasionally palpable on examination. These are usually present to the left of the midline.
Fluoroscopic barium esophagography is the mainstay of the diagnosis of the Zenker diverticulum.
Patients with minimal symptomatology who do not desire surgical therapy may be followed up on a routine outpatient basis by monitoring their symptoms.
Several surgical options exist; however, the approach most frequently cited is myotomy of the cricopharyngeus muscle with or without diverticulopexy. Endoscopic treatment of Zenker's diverticulum, including endoscopic stapling, holds promise and is currently being investigated in clinical trials.



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18 comments

  1. Anonymous Says:
  2. zenkers diverticula

     
  3. zenkers

     
  4. Anonymous Says:
  5. oesophegeal cancer

     
  6. Anonymous Says:
  7. pharyngoesophageal diverticulum , or Esophogeal Cancer

     
  8. Anonymous Says:
  9. Esophogeal Cancer

     
  10. Anonymous Says:
  11. esophageal diverticulum ???

     
  12. Anonymous Says:
  13. retropharyngeal pouch

     
  14. hammam alloh Says:
  15. pharyngeal pouch

     
  16. Anonymous Says:
  17. Zenkers Diverticulum

     
  18. Anonymous Says:
  19. géant
    diverticule de zenker

     
  20. Anonymous Says:
  21. cancer (esophageal)

     
  22. Anonymous Says:
  23. Esophogeal Cancer

     
  24. Anonymous Says:
  25. Zenker diverticulum

     
  26. Anonymous Says:
  27. radiiv.ograph shows diverticulum,that is zenkers d

     
  28. Anonymous Says:
  29. Diverticulo esofagico

     
  30. Anonymous Says:
  31. Diverticulo de Zenker!!! :)

     
  32. Anonymous Says:
  33. unintentional weight loss in a man with dysphagia?

     
  34. Anonymous Says:
  35. DIVERTICULO DE ZENKER

     

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