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QJM Advance Access originally published online on July 22, 2008
QJM 2008 101(9):747-748; doi:10.1093/qjmed/hcn081
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© The Author 2008. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Zenker's diverticulum

E.E. McGrath, J. McCabe and A. Odudu

Department of Respiratory Medicine, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK.

email: e.mcgrath{at}sheffield.ac.uk

An 86-year-old male with a background of pulmonary fibrosis and asthma was admitted to hospital with a six-month history of a productive cough. He produced approximately one teaspoon of white sputum per day but noticed that the cough was exacerbated significantly after eating dry food. At meal times he experienced slight dysphagia and coughed up some of the ingested food including his medications. His X-ray on admission showed evidence of pulmonary fibrosis but did not obviously highlight a cause for his current medical admission (Figure 1). We investigated him further by performing a barium swallow which demonstrated a pharyngeal pouch (Zenker's diverticulum) (Figure 2). Incidentally, a chest X-ray performed after the barium swallow highlighted the pharyngeal pouch containing the ingested barium that was not as obvious on his admission chest X-ray (Figure 3).


Figure 1
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  		Figure 1. Chest x-ray demonstrating diffuse interstitial changes consistent with pulmonary fibrosis.

 

Figure 2
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  		Figure 2. Barium swallow demonstrating barium collection in a pharyngeal pouch.

 

Figure 3
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  		Figure 3. A follow up x-ray post barium swallow demonstrating a now more visible pharyngeal pouch.

 
Zenker's diverticulum results when the oesophageal mucosa herniates posteriorly between the cricopharyngeus muscle and the inferior pharyngeal constrictor muscles. It is more common in males than females and tends to occur in the seventh decade of life or later.1 An annual incidence of 2 per 100 000 people per year has been described in a community study from the UK.2 Symptoms include dysphagia, choking, chronic cough, regurgitation of undigested food, halitosis, weight loss and chronic aspiration. Treatment involves surgery with an external or endoscopic approach to eliminate the diverticular pouch.

This patient has subsequently been referred to our surgical colleagues for assessment.

Conflict of interest: None declared.


   References
Top
 References
 
1. Maran AGD, Wilson JA, Al Muhanna AH. Pharyngeal diverticula. Clin Otolaryngol (1986) 11:219–25.[CrossRef][Web of Science][Medline]

2. Bradley PJ, Kochaar A, Quraishi MS. Pharyngeal pouch carcinoma: real or imaginary risks? Ann Otol Rhinol Laryngol (1999) 108:1027–32.[Web of Science][Medline]


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This Article
Right arrow Extract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
101/9/747    most recent
hcn081v1
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Right arrow Articles by McGrath, E.E.
Right arrow Articles by Odudu, A.
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PubMed
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Right arrow Articles by McGrath, E.E.
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