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대한흉부영상의학회 Weekly Case 검색
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Weekly Chest CasesArchive of Old Cases

Case No : 55 Date 1998-11-16

  • Courtesy of Hyae Young Kim, M.D., Jin Seong Lee, M.D., Koun-Sik Song, M.D. / Ulsan University Asan Medical Center
  • Age/Sex 63 / M
  • Chief ComplaintChest PA abnormality, no specific chest symptom
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Chest PA

Diagnosis With Brief Discussion

Diagnosis
Epiphrenic Esophageal Diverticulum
Radiologic Findings
Chest PA shows a prominent bulge along the right border of the heart, suggesting mediastinal mass. Air shadows are noted within the mass. CT scan shows a mass with air-fluid level. Esophagogastric junction is located in normal position and the contour of stomach is also normal. Endoscopy reveals not hiatal hernia but epiphrenic esophageal diverticulum.
Brief Review
True esophageal diverticula consist of only mucosa without a muscular layer. Diverticula may be classified by their location or by their mechanism of formation. The most common locations include the pharyngoesophageal junction (i.e., Zenker’s diverticulum), the midesophagus, and the distal esophagus just above the esophageal hiatus (i.e., epiphrenic diverticulum). Diverticula may be formed either by pulsion due to increased intraluminal esophageal pressure or by traction due to fibrosis in adjacent periesophageal tissue.
Epiphrenic diverticulum is typically seen as a thin walled, air or air-fluid filled structure communicating with the esophagus. However, those not associated with a distal esophageal obstruction (stricture, achalasia) may remain contracted in resting state and thus may not be visible. Occasionally the diverticulum may have to be differentiated from mediastinal abscess or tumors and even hiatus hernia.
References
1. Levin MS. Miscellaneous abnormalities. In Gore RM, Levine MS, Laufer I. Textbook of gastrointestinal radiology. 1st ed. Philadelphia : Saunders, 1994: 525-527.
2. Kim KW, Berkmen YM, Auh YH, Kazam E. Diagnosis of epiphrenic esophageal diverticulum by computed tomography. Journal of Computed Tomography. 1988;12(1):25-8.
Keywords
Esophagus, Congenital, diverticulum,

No. of Applicants : 21

▶ Correct Answer : 4/21,  19.0%
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  • - 臾몄„깆š
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▶ Semi-Correct Answer : 14/21,  66.7%
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  • - Northwestern Memorial Hospital, Chicago, IL., USA Mitchell J. Kline
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