Radiological Case: Intraluminal Esophageal Diverticulum

Ahmed A. Mohammed, MD; Bernadette Diegnan, MD; Paulomi Kanzaria, MD

Disclosures

Appl Radiol. 2017;46(8):28-30. 

In This Article

Discussion

Intraluminal esophageal diverticulum is a rare entity that was first described radiologically by Nelson in 1947.[1] Intraluminal esophageal diverticulae are usually related to mucosal damage secondary to increased intraluminal pressure.[2] There is a pouch of mucosal membrane that is open proximally and closed distally.[3] Although they may be congenital, intraluminal esophageal diverticulae tend to be acquired lesions related to mucosal damage secondary to increased intraluminal pressure in the esophagus that has been narrowed by an inflammatory process.[4]

In our case, a large collection of intraluminal barium with surrounding radiolucent halo (Figure 3) and distal esophageal narrowing (Figure 4) was demonstrated on barium swallow, indicating the existence of the diverticular structure which communicated with the esophageal lumen.

The concept of intraluminal esophageal diverticulum (IED) was presented by Schreiber and Davis in 1977.[3] They reported the first two cases of IED. Grand and L'Hermin reported another case of IED.[5] In these cases, radiological findings were not reproducible on repeat barium meals and no diverticula were found by esophagoscopy.[6]

Cho et al[7] reported three additional cases and considered this finding as a transient artifactual phenomenon created by the interface of the barium bolus with the viscous secretion or air.[6] The same radiological artifactual phenomena were observed in the stomach.[10–13]

It has been suggested that IED is caused by a partial esophageal web, which elongates distally with propulsive peristaltic pressure and forms a pocket-like structure within the esophageal lumen. The congenital or acquired mucosal weakness of the esophageal wall may be another contributing factor as mentioned.[3,5,6,8]

The radiological findings of IED are identical to those of intraluminal diverticula of other parts of the alimentary tract.[9] An intraluminal barium collection surrounded by a radiolucent halo is a characteristic finding. A transient radiological artifact closely resembling IED is the important differential diagnosis with a true lesion. True IED is reproducible on repeat barium study and is recognized at endoscopic examination.[6]

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