Learning objectives
Become familiar with the diverticula of the gastrointestinal tract.
Understand the modality of choice and the imaging features for each diverticulum.
Avoid diagnostic pitfalls and recognize the common complications of diverticular disease.
Background
Diverticula are congenital or acquired outpouchings of the gastrointestinal (GI) tract,
normally occurring at points of weakness in the wall of the alimentary canal secondary to traction (pulling) or pulsion (increased intraluminal pressure) forces.
Congenital diverticula are true diverticulum,
involving all three layer of the bowel wall: the mucosa,
the smooth muscle,
and the serosa.
Acquired diverticula are characteristically false diverticulum which do not involve all three layer and are usually a mucosal outpouching through a defect in the muscular layer.
While often asymptomatic,
GI...
Findings and procedure details
HYPOPHARYNGEAL/ESOPHAGEAL DIVERTICULUM
Fluoroscopic esophagram is the gold standard for diagnosis of diverticulum of the upper GI tract.
These diverticula are often incidentally discovered on fluoroscopic swallow studies performed for other indications.
A pitfall of this technique occurs when small diverticula are obscuredby superposition on the main column of barium in the esophagus.
This can be overcome by rotating the patient.Using continuous video fluoroscopy in anteroposterior (AP) and lateral projections can improve sensitivity for small diverticula and show evidence of overflow or aspiration.
-Zenker’s Diverticulum
A...
Conclusion
Radiologists should be familiar with the spectrum of GI tract diverticular disease.
An understanding of the image modalities available is key for initial diagnosis of the disease,
especially in the setting of acute symptoms or complications.
While diverticula are often asymptomatic,
medical management or surgical correction may be necessary in the setting of chronic symptoms or acute complications.
Personal information
Dr.
Roozbeh Houshyar & Dr.
Mohammad Helmy
Abdominal Imaging Section.
Department of Radiology,University of California Irvine Medical Center.
101 The City Drive South,
Orange,
California 92868.
Email:
[email protected],
[email protected]
Dr.
Rebecca Bennett
Radiology Resident.
University of California Irvine Medical Center.
Email:
[email protected]
References
Ferreira LE,
Simmons DT,
Baron TH.
Zenker's diverticula: pathophysiology,
clinical presentation,
and flexible endoscopic management.
Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus. 2008;21(1):1-8.
Law R,
Katzka DA,
Baron TH.
Zenker's Diverticulum.
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 2014;12(11):1773-1782.
Rubesin SE,
Levine MS.
Killian-Jamieson diverticula: radiographic findings in 16 patients.
AJR American journal of roentgenology. 2001;177(1):85-89.
Rodgers PJ,
Armstrong WB,
Dana E.
Killian-Jamieson diverticulum: a case report and...