Case 37 - Pulsion (epiphrenic) diverticulum

Summary

Imaging description

A lower esophageal pulsion (epiphrenic) diverticulum contains some combination of air, fluid, and debris by CT chest. It may have an obvious connection to the esophagus because of a wide neck. The remainder of the esophagus may be distended since epiphrenic diverticula are caused by partial distal esophageal obstruction. Esophagram can confirm a suspected epiphrenic diverticulum by demonstration of a blind pouch, usually projecting to the right, connected to the distal esophagus by a neck. The diverticulum retains barium (Figure 37.1). Frequently, the esophagram also provides information regarding the functional or mechanical cause of partial distal esophageal obstruction.

Importance

Pulsion (epiphrenic) diverticula of the thoracic esophagus are less common than pulsion (Zenker) diverticula of the cervical esophagus [1]. Pathologically, a pulsion diverticulum forms when the mucosal and submucosal layers of the bowel are pushed through the muscular layers by increased intraluminal pressure. Pulsion diverticula of the thoracic esophagus typically arise distally secondary to increased intraluminal pressure caused by distal esophageal functional (motility disorder) or mechanical obstruction [2].