Investigation of choice for Zenker's diveculum is:
A i.e. Barium swallow: Zenker (pharygo-esophageal) diveiculum is an acquired pulsion diveiculum herniating through Kilian dehiscenceQ, an area of congenital weakness between the horizontal & oblique fibers of cricopharyngeus muscle. It is outpouching of posterior hypopharyngeal wall (mucosa & sub mucosa) through oblique & transverse muscle bundles (pseudo-diveiculum) of cricopharyngeal muscle at pharyngoesophageal junction in the midline of Killian dehiscence (triangle of Laimer), at level of Cs-_& It may present with upper oesophageal dysphagia (as diveiculum fills preferentially Zeinker diveiculum (Posterior) with food & obstructs the lumen of oesophagus), compressible neck mass, regurgitation (+- aspiration) of undigested pouch content (food), noisy deglutition and halitosis (foul breath). Aspiration (30%), perforation & carcinoma (0.5%) are possible complications. - X-ray demonstrates air fluid level in superior mediastinum. Barium swallow is investigation of choiceQ and demonstrates barium filled sac (or bulge) extending posterirly just above cricopharyngeal impression in upper half of semilunar depression (on lateral view); extending caudally & usually to the left below the arcuate line of piriform sinuses (on frontal view) with paial or complete obstruction of oesophagus from external pressure of sac contents. - Once suspected, clinically & radiologically, the diagnosis of Zenker's diveiculum is estabilished by barrium swallomQ. No other study is often required. Endoscopy is usually difficult & potentially dangerousQ, owing to obstruction of true oesophageal lumen by the diveiculum 1/t increased risk of diveicular perforation. Killian-Jamieson Pouch (diveicula) are protrusion arising on anterolateral wall of proximal cervical oesophagus just below the level of cricopharyngeus, in region of anatomic weakness caused by passage of inferior laryngeal nerve.
Barium swallow
Endoscopy
Esophageal Menometry
CT