A 62-year-old woman was admitted with an episode of aspiration pneumonia

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Educational Objective:

Identify esophageal diverticulum.

Key Point:

An esophageal diverticulum is an outpouching of the esophagus that can cause dysphagia, regurgitation, and nocturnal cough. It can be the trigger for episodes of aspiration pneumonia.

Explanation:

Esophageal diverticulum, sometimes called Zenker diverticulum when located in proximity to the upper esophageal sphincter, is an outpouching or sac of the esophagus that can cause dysphagia, regurgitation, and nocturnal cough. On occasions it can trigger episodes of aspiration pneumonia.

Another image shows posterior indentation in the esophagus. This may represent a compressing external mass. In this case it was a vascular ring. Yet another image shows dilatation of esophagus and a "bird's beak" appearance of the gastroesophageal junction characteristic of achalasia. The other image shows a nutcracker esophagus, which is characteristic of esophageal spasms.

References:

Baylor College of Medicine. Plain radiographic diagnosis of congenital heart disease. Accessed July 31, 2017.

Bragg J. Esophageal diverticula clinical presentation. Accessed July 31, 2017.

DxLine. Esophageal spasm. Accessed July 31, 2017.

Law R, Katzka DA, Baron TH. Zenker's diverticulum. Clin Gastroenterol Hepatol. 2014;12(11):1773-1782.

Minimally Invasive Surgery Specialists. Achalasia. Accessed July 31, 2017.

Smith CD. Esophageal strictures and diverticula. Surg Clin North Am. 2015;95(3):669-681.